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 $21.88 Median $22.91 Typical High $22.91 | Professional | None | $21.88 | $22.91 | $22.91 |
Anthem BCBS Setting Facility Modifier None Typical Low $37.15 Median $46.77 Typical High $89.13 | Facility | None | $37.15 | $46.77 | $89.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $20.89 Median $20.89 Typical High $22.91 | Professional | None | $20.89 | $20.89 | $22.91 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $2.04 Median $2.04 Typical High $2.29 | Professional | RR · Rental | $2.04 | $2.04 | $2.29 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $15.49 Median $15.49 Typical High $16.98 | Professional | UE · Used equipment | $15.49 | $15.49 | $16.98 |
Cigna Setting Facility Modifier None Typical Low $21.38 Median $21.38 Typical High $23.44 | Facility | None | $21.38 | $21.38 | $23.44 |
Cigna Setting Professional Modifier None Typical Low $15.49 Median $15.49 Typical High $21.38 | Professional | None | $15.49 | $15.49 | $21.38 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $14.45 Median $32.36 Typical High $42.66 | Professional | None | $14.45 | $32.36 | $42.66 |
Martin's Point Setting Professional Modifier None Typical Low $21.88 Median $22.91 Typical High $22.91 | Professional | None | $21.88 | $22.91 | $22.91 |
United Setting Professional Modifier None Typical Low $14.45 Median $18.62 Typical High $51.29 | Professional | None | $14.45 | $18.62 | $51.29 |
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 $10.96 Median $11.22 Typical High $11.22 | Professional | 52 · Reduced service | $10.96 | $11.22 | $11.22 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.37 Median $4.57 Typical High $4.57 | Professional | 53 · Discontinued | $4.37 | $4.57 | $4.57 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.24 Median $3.39 Typical High $3.39 | Professional | 55 · Aftercare only | $3.24 | $3.39 | $3.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.19 Median $2.29 Typical High $2.29 | Professional | 56 · Pre-op care only | $2.19 | $2.29 | $2.29 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $10.96 Median $11.22 Typical High $11.22 | Professional | 52 · Reduced service | $10.96 | $11.22 | $11.22 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $4.37 Median $4.57 Typical High $4.57 | Professional | 53 · Discontinued | $4.37 | $4.57 | $4.57 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.24 Median $3.39 Typical High $3.39 | Professional | 55 · Aftercare only | $3.24 | $3.39 | $3.39 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.19 Median $2.29 Typical High $2.29 | Professional | 56 · Pre-op care only | $2.19 | $2.29 | $2.29 |
Where Maine sits
The same service costs 3.1 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· 31st of 51
$20.89
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.