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 $47.86 Median $52.48 Typical High $107.15 | Professional | None | $47.86 | $52.48 | $107.15 |
Anthem BCBS Setting Facility Modifier None Typical Low $85.11 Median $109.65 Typical High $208.93 | Facility | None | $85.11 | $109.65 | $208.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $39.81 Median $46.77 Typical High $47.86 | Professional | None | $39.81 | $46.77 | $47.86 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $4.68 Median $4.68 Typical High $5.13 | Professional | RR · Rental | $4.68 | $4.68 | $5.13 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $34.67 Median $34.67 Typical High $38.02 | Professional | UE · Used equipment | $34.67 | $34.67 | $38.02 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $56.23 Typical High $61.66 | Facility | None | $56.23 | $56.23 | $61.66 |
Cigna Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $56.23 | Professional | None | $40.74 | $40.74 | $56.23 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $33.88 Median $75.86 Typical High $100.00 | Professional | None | $33.88 | $75.86 | $100.00 |
Martin's Point Setting Professional Modifier None Typical Low $47.86 Median $52.48 Typical High $107.15 | Professional | None | $47.86 | $52.48 | $107.15 |
United Setting Professional Modifier None Typical Low $33.88 Median $43.65 Typical High $120.23 | Professional | None | $33.88 | $43.65 | $120.23 |
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 $25.12 Median $26.30 Typical High $26.30 | Professional | 52 · Reduced service | $25.12 | $26.30 | $26.30 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.00 Median $10.47 Typical High $10.47 | Professional | 53 · Discontinued | $10.00 | $10.47 | $10.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $7.94 Typical High $7.94 | Professional | 55 · Aftercare only | $7.59 | $7.94 | $7.94 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.01 Median $5.25 Typical High $5.25 | Professional | 56 · Pre-op care only | $5.01 | $5.25 | $5.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $25.12 Median $26.30 Typical High $26.30 | Professional | 52 · Reduced service | $25.12 | $26.30 | $26.30 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.00 Median $10.47 Typical High $10.47 | Professional | 53 · Discontinued | $10.00 | $10.47 | $10.47 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $7.94 Typical High $7.94 | Professional | 55 · Aftercare only | $7.59 | $7.94 | $7.94 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.01 Median $5.25 Typical High $5.25 | Professional | 56 · Pre-op care only | $5.01 | $5.25 | $5.25 |
Where Maine sits
The same service costs 3.1 times more in Hawaii 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· 34th of 51
$47.86
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.