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 $52.48 Median $54.95 Typical High $112.20 | Professional | None | $52.48 | $54.95 | $112.20 |
Anthem BCBS Setting Facility Modifier None Typical Low $89.13 Median $114.82 Typical High $213.80 | Facility | None | $89.13 | $114.82 | $213.80 |
Anthem BCBS Setting Professional Modifier None Typical Low $38.02 Median $50.12 Typical High $53.70 | Professional | None | $38.02 | $50.12 | $53.70 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $4.90 Median $4.90 Typical High $5.37 | Professional | RR · Rental | $4.90 | $4.90 | $5.37 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $37.15 Median $37.15 Typical High $40.74 | Professional | UE · Used equipment | $37.15 | $37.15 | $40.74 |
Cigna Setting Facility Modifier None Typical Low $61.66 Median $61.66 Typical High $67.61 | Facility | None | $61.66 | $61.66 | $67.61 |
Cigna Setting Professional Modifier None Typical Low $44.67 Median $44.67 Typical High $61.66 | Professional | None | $44.67 | $44.67 | $61.66 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $34.67 Median $79.43 Typical High $102.33 | Professional | None | $34.67 | $79.43 | $102.33 |
Martin's Point Setting Professional Modifier None Typical Low $52.48 Median $54.95 Typical High $112.20 | Professional | None | $52.48 | $54.95 | $112.20 |
United Setting Professional Modifier None Typical Low $34.67 Median $44.67 Typical High $123.03 | Professional | None | $34.67 | $44.67 | $123.03 |
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 $26.30 Median $27.54 Typical High $27.54 | Professional | 52 · Reduced service | $26.30 | $27.54 | $27.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $10.96 Typical High $10.96 | Professional | 53 · Discontinued | $10.47 | $10.96 | $10.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $8.13 Typical High $8.13 | Professional | 55 · Aftercare only | $7.76 | $8.13 | $8.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $5.50 Typical High $5.50 | Professional | 56 · Pre-op care only | $5.25 | $5.50 | $5.50 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $26.30 Median $27.54 Typical High $27.54 | Professional | 52 · Reduced service | $26.30 | $27.54 | $27.54 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $10.96 Typical High $10.96 | Professional | 53 · Discontinued | $10.47 | $10.96 | $10.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $8.13 Typical High $8.13 | Professional | 55 · Aftercare only | $7.76 | $8.13 | $8.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $5.50 Typical High $5.50 | Professional | 56 · Pre-op care only | $5.25 | $5.50 | $5.50 |
Where Maine sits
The same service costs 2.3 times more in Kansas 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· 31st of 51
$53.70
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.