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 $32.36 Median $35.48 Typical High $35.48 | Professional | None | $32.36 | $35.48 | $35.48 |
Anthem BCBS Setting Facility Modifier None Typical Low $57.54 Median $74.13 Typical High $141.25 | Facility | None | $57.54 | $74.13 | $141.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $31.62 Median $31.62 Typical High $34.67 | Professional | None | $31.62 | $31.62 | $34.67 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $3.16 Median $3.16 Typical High $3.47 | Professional | RR · Rental | $3.16 | $3.16 | $3.47 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $23.99 Median $23.99 Typical High $26.30 | Professional | UE · Used equipment | $23.99 | $23.99 | $26.30 |
Cigna Setting Facility Modifier None Typical Low $33.11 Median $33.11 Typical High $35.48 | Facility | None | $33.11 | $33.11 | $35.48 |
Cigna Setting Professional Modifier None Typical Low $24.55 Median $24.55 Typical High $33.11 | Professional | None | $24.55 | $24.55 | $33.11 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $22.91 Median $51.29 Typical High $67.61 | Professional | None | $22.91 | $51.29 | $67.61 |
Martin's Point Setting Professional Modifier None Typical Low $32.36 Median $35.48 Typical High $35.48 | Professional | None | $32.36 | $35.48 | $35.48 |
United Setting Professional Modifier None Typical Low $22.91 Median $28.84 Typical High $81.28 | Professional | None | $22.91 | $28.84 | $81.28 |
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 $16.98 Median $17.78 Typical High $17.78 | Professional | 52 · Reduced service | $16.98 | $17.78 | $17.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.76 Median $7.08 Typical High $7.08 | Professional | 53 · Discontinued | $6.76 | $7.08 | $7.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.13 Median $5.37 Typical High $5.37 | Professional | 55 · Aftercare only | $5.13 | $5.37 | $5.37 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.39 Median $3.55 Typical High $3.55 | Professional | 56 · Pre-op care only | $3.39 | $3.55 | $3.55 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $16.98 Median $17.78 Typical High $17.78 | Professional | 52 · Reduced service | $16.98 | $17.78 | $17.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $6.76 Median $7.08 Typical High $7.08 | Professional | 53 · Discontinued | $6.76 | $7.08 | $7.08 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $5.13 Median $5.37 Typical High $5.37 | Professional | 55 · Aftercare only | $5.13 | $5.37 | $5.37 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.39 Median $3.55 Typical High $3.55 | Professional | 56 · Pre-op care only | $3.39 | $3.55 | $3.55 |
Where Maine sits
The same service costs 2.8 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· 35th of 51
$31.62
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.