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 $22.39 Median $24.55 Typical High $24.55 | Professional | None | $22.39 | $24.55 | $24.55 |
Anthem BCBS Setting Facility Modifier None Typical Low $39.81 Median $51.29 Typical High $97.72 | Facility | None | $39.81 | $51.29 | $97.72 |
Anthem BCBS Setting Professional Modifier None Typical Low $13.18 Median $13.18 Typical High $14.79 | Professional | None | $13.18 | $13.18 | $14.79 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $10.00 Median $10.00 Typical High $10.96 | Professional | UE · Used equipment | $10.00 | $10.00 | $10.96 |
Cigna Setting Facility Modifier None Typical Low $22.91 Median $22.91 Typical High $25.70 | Facility | None | $22.91 | $22.91 | $25.70 |
Cigna Setting Professional Modifier None Typical Low $16.98 Median $16.98 Typical High $22.91 | Professional | None | $16.98 | $16.98 | $22.91 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $15.85 Median $35.48 Typical High $46.77 | Professional | None | $15.85 | $35.48 | $46.77 |
Martin's Point Setting Professional Modifier None Typical Low $22.39 Median $24.55 Typical High $24.55 | Professional | None | $22.39 | $24.55 | $24.55 |
United Setting Professional Modifier None Typical Low $15.85 Median $19.95 Typical High $56.23 | Professional | None | $15.85 | $19.95 | $56.23 |
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 $11.75 Median $12.30 Typical High $12.30 | Professional | 52 · Reduced service | $11.75 | $12.30 | $12.30 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.68 Median $4.90 Typical High $4.90 | Professional | 53 · Discontinued | $4.68 | $4.90 | $4.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.55 Median $3.63 Typical High $3.63 | Professional | 55 · Aftercare only | $3.55 | $3.63 | $3.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.34 Median $2.45 Typical High $2.45 | Professional | 56 · Pre-op care only | $2.34 | $2.45 | $2.45 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $11.75 Median $12.30 Typical High $12.30 | Professional | 52 · Reduced service | $11.75 | $12.30 | $12.30 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $4.68 Median $4.90 Typical High $4.90 | Professional | 53 · Discontinued | $4.68 | $4.90 | $4.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.55 Median $3.63 Typical High $3.63 | Professional | 55 · Aftercare only | $3.55 | $3.63 | $3.63 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.34 Median $2.45 Typical High $2.45 | Professional | 56 · Pre-op care only | $2.34 | $2.45 | $2.45 |
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· 43rd of 51
$19.95
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.