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 $35.48 Median $38.90 Typical High $38.90 | Professional | None | $35.48 | $38.90 | $38.90 |
Anthem BCBS Setting Facility Modifier None Typical Low $63.10 Median $81.28 Typical High $154.88 | Facility | None | $63.10 | $81.28 | $154.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $29.51 Median $35.48 Typical High $38.02 | Professional | None | $29.51 | $35.48 | $38.02 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $3.47 Median $3.47 Typical High $3.80 | Professional | RR · Rental | $3.47 | $3.47 | $3.80 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $25.70 Median $25.70 Typical High $28.18 | Professional | UE · Used equipment | $25.70 | $25.70 | $28.18 |
Cigna Setting Facility Modifier None Typical Low $37.15 Median $37.15 Typical High $40.74 | Facility | None | $37.15 | $37.15 | $40.74 |
Cigna Setting Professional Modifier None Typical Low $26.92 Median $26.92 Typical High $37.15 | Professional | None | $26.92 | $26.92 | $37.15 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $25.12 Median $56.23 Typical High $74.13 | Professional | None | $25.12 | $56.23 | $74.13 |
Martin's Point Setting Professional Modifier None Typical Low $35.48 Median $38.90 Typical High $38.90 | Professional | None | $35.48 | $38.90 | $38.90 |
United Setting Professional Modifier None Typical Low $25.12 Median $32.36 Typical High $89.13 | Professional | None | $25.12 | $32.36 | $89.13 |
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 $18.62 Median $19.50 Typical High $19.50 | Professional | 52 · Reduced service | $18.62 | $19.50 | $19.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $7.76 Typical High $7.76 | Professional | 53 · Discontinued | $7.41 | $7.76 | $7.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $5.89 Typical High $5.89 | Professional | 55 · Aftercare only | $5.62 | $5.89 | $5.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.72 Median $3.89 Typical High $3.89 | Professional | 56 · Pre-op care only | $3.72 | $3.89 | $3.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $18.62 Median $19.50 Typical High $19.50 | Professional | 52 · Reduced service | $18.62 | $19.50 | $19.50 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $7.76 Typical High $7.76 | Professional | 53 · Discontinued | $7.41 | $7.76 | $7.76 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $5.89 Typical High $5.89 | Professional | 55 · Aftercare only | $5.62 | $5.89 | $5.89 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.72 Median $3.89 Typical High $3.89 | Professional | 56 · Pre-op care only | $3.72 | $3.89 | $3.89 |
Where Maine sits
The same service costs 2.6 times more in Montana 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· 30th of 51
$37.15
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.