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 $38.90 Median $51.29 Typical High $51.29 | Professional | None | $38.90 | $51.29 | $51.29 |
Anthem BCBS Setting Facility Modifier None Typical Low $83.18 Median $107.15 Typical High $199.53 | Facility | None | $83.18 | $107.15 | $199.53 |
Anthem BCBS Setting Professional Modifier None Typical Low $33.88 Median $40.74 Typical High $43.65 | Professional | None | $33.88 | $40.74 | $43.65 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $3.98 Median $3.98 Typical High $4.37 | Professional | RR · Rental | $3.98 | $3.98 | $4.37 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $29.51 Median $29.51 Typical High $32.36 | Professional | UE · Used equipment | $29.51 | $29.51 | $32.36 |
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 $33.11 Median $74.13 Typical High $95.50 | Professional | None | $33.11 | $74.13 | $95.50 |
Martin's Point Setting Professional Modifier None Typical Low $38.90 Median $51.29 Typical High $51.29 | Professional | None | $38.90 | $51.29 | $51.29 |
United Setting Facility Modifier None Typical Low $43.65 Median $43.65 Typical High $43.65 | Facility | None | $43.65 | $43.65 | $43.65 |
United Setting Professional Modifier None Typical Low $33.11 Median $41.69 Typical High $117.49 | Professional | None | $33.11 | $41.69 | $117.49 |
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 $19.95 Median $25.70 Typical High $25.70 | Professional | 52 · Reduced service | $19.95 | $25.70 | $25.70 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $10.23 Typical High $10.23 | Professional | 53 · Discontinued | $7.94 | $10.23 | $10.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.03 Median $7.59 Typical High $7.59 | Professional | 55 · Aftercare only | $6.03 | $7.59 | $7.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.98 Median $5.13 Typical High $5.13 | Professional | 56 · Pre-op care only | $3.98 | $5.13 | $5.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $19.95 Median $25.70 Typical High $25.70 | Professional | 52 · Reduced service | $19.95 | $25.70 | $25.70 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $10.23 Typical High $10.23 | Professional | 53 · Discontinued | $7.94 | $10.23 | $10.23 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $6.03 Median $7.59 Typical High $7.59 | Professional | 55 · Aftercare only | $6.03 | $7.59 | $7.59 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.98 Median $5.13 Typical High $5.13 | Professional | 56 · Pre-op care only | $3.98 | $5.13 | $5.13 |
Where Maine sits
The same service costs 3.1 times more in Hawaii than in Kentucky. 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· 27th of 51
$43.65
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.