How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier None Typical Low $302.00 Median $331.13 Typical High $346.74 | Professional | None | $302.00 | $331.13 | $346.74 |
Anthem BCBS Setting Facility Modifier None Typical Low $549.54 Median $691.83 Typical High $1,318.26 | Facility | None | $549.54 | $691.83 | $1,318.26 |
Anthem BCBS Setting Professional Modifier None Typical Low $199.53 Median $234.42 Typical High $251.19 | Professional | None | $199.53 | $234.42 | $251.19 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $22.91 Median $22.91 Typical High $25.12 | Professional | RR · Rental | $22.91 | $22.91 | $25.12 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $199.53 Median $199.53 Typical High $218.78 | Professional | UE · Used equipment | $199.53 | $199.53 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $316.23 Median $316.23 Typical High $407.38 | Facility | None | $316.23 | $316.23 | $407.38 |
Cigna Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $316.23 | Professional | None | $229.09 | $229.09 | $316.23 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $213.80 Median $478.63 Typical High $630.96 | Professional | None | $213.80 | $478.63 | $630.96 |
Martin's Point Setting Professional Modifier None Typical Low $302.00 Median $331.13 Typical High $346.74 | Professional | None | $302.00 | $331.13 | $346.74 |
United Setting Professional Modifier None Typical Low $213.80 Median $275.42 Typical High $758.58 | Professional | None | $213.80 | $275.42 | $758.58 |
8 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $158.49 Median $165.96 Typical High $165.96 | Professional | 52 · Reduced service | $158.49 | $165.96 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $64.57 Median $67.61 Typical High $67.61 | Professional | 53 · Discontinued | $64.57 | $67.61 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $47.86 Median $50.12 Typical High $50.12 | Professional | 55 · Aftercare only | $47.86 | $50.12 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $31.62 Median $33.11 Typical High $33.11 | Professional | 56 · Pre-op care only | $31.62 | $33.11 | $33.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $158.49 Median $165.96 Typical High $165.96 | Professional | 52 · Reduced service | $158.49 | $165.96 | $165.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $64.57 Median $67.61 Typical High $67.61 | Professional | 53 · Discontinued | $64.57 | $67.61 | $67.61 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $47.86 Median $50.12 Typical High $50.12 | Professional | 55 · Aftercare only | $47.86 | $50.12 | $50.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $31.62 Median $33.11 Typical High $33.11 | Professional | 56 · Pre-op care only | $31.62 | $33.11 | $33.11 |
Where Maine sits
The same service costs 2.6 times more in Montana than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
Maine· 28th of 51
$316
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.