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 $26.30 Median $33.88 Typical High $69.18 | Professional | None | $26.30 | $33.88 | $69.18 |
Anthem BCBS Setting Facility Modifier None Typical Low $54.95 Median $70.79 Typical High $131.83 | Facility | None | $54.95 | $70.79 | $131.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $33.88 | Professional | None | $30.90 | $30.90 | $33.88 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $3.09 Median $3.09 Typical High $3.39 | Professional | RR · Rental | $3.09 | $3.09 | $3.39 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $22.91 Median $22.91 Typical High $25.12 | Professional | UE · Used equipment | $22.91 | $22.91 | $25.12 |
Cigna Setting Facility Modifier None Typical Low $33.11 Median $33.11 Typical High $37.15 | Facility | None | $33.11 | $33.11 | $37.15 |
Cigna Setting Professional Modifier None Typical Low $23.99 Median $23.99 Typical High $33.11 | Professional | None | $23.99 | $23.99 | $33.11 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $21.38 Median $48.98 Typical High $63.10 | Professional | None | $21.38 | $48.98 | $63.10 |
Martin's Point Setting Professional Modifier None Typical Low $32.36 Median $33.88 Typical High $41.69 | Professional | None | $32.36 | $33.88 | $41.69 |
United Setting Professional Modifier None Typical Low $21.38 Median $27.54 Typical High $75.86 | Professional | None | $21.38 | $27.54 | $75.86 |
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 $16.22 Median $16.98 Typical High $16.98 | Professional | 52 · Reduced service | $16.22 | $16.98 | $16.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.46 Median $6.76 Typical High $6.76 | Professional | 53 · Discontinued | $6.46 | $6.76 | $6.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.79 Median $5.01 Typical High $5.01 | Professional | 55 · Aftercare only | $4.79 | $5.01 | $5.01 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.24 Median $3.39 Typical High $3.39 | Professional | 56 · Pre-op care only | $3.24 | $3.39 | $3.39 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $16.22 Median $16.98 Typical High $16.98 | Professional | 52 · Reduced service | $16.22 | $16.98 | $16.98 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $6.46 Median $6.76 Typical High $6.76 | Professional | 53 · Discontinued | $6.46 | $6.76 | $6.76 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $4.79 Median $5.01 Typical High $5.01 | Professional | 55 · Aftercare only | $4.79 | $5.01 | $5.01 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.24 Median $3.39 Typical High $3.39 | Professional | 56 · Pre-op care only | $3.24 | $3.39 | $3.39 |
Where Maine sits
The same service costs 2.6 times more in Montana than in Kansas. 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· 30th of 51
$32.36
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.