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 $42.66 Median $44.67 Typical High $44.67 | Professional | None | $42.66 | $44.67 | $44.67 |
Anthem BCBS Setting Facility Modifier None Typical Low $72.44 Median $93.33 Typical High $173.78 | Facility | None | $72.44 | $93.33 | $173.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $44.67 | Professional | None | $40.74 | $40.74 | $44.67 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $4.07 Median $4.07 Typical High $4.47 | Professional | RR · Rental | $4.07 | $4.07 | $4.47 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $30.90 Median $30.90 Typical High $33.88 | Professional | UE · Used equipment | $30.90 | $30.90 | $33.88 |
Cigna Setting Facility Modifier None Typical Low $41.69 Median $41.69 Typical High $44.67 | Facility | None | $41.69 | $41.69 | $44.67 |
Cigna Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $41.69 | Professional | None | $30.90 | $30.90 | $41.69 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $28.84 Median $64.57 Typical High $83.18 | Professional | None | $28.84 | $64.57 | $83.18 |
Martin's Point Setting Professional Modifier None Typical Low $42.66 Median $44.67 Typical High $44.67 | Professional | None | $42.66 | $44.67 | $44.67 |
United Setting Professional Modifier None Typical Low $28.84 Median $36.31 Typical High $102.33 | Professional | None | $28.84 | $36.31 | $102.33 |
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 $21.38 Median $22.39 Typical High $22.39 | Professional | 52 · Reduced service | $21.38 | $22.39 | $22.39 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.51 Median $8.91 Typical High $8.91 | Professional | 53 · Discontinued | $8.51 | $8.91 | $8.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.31 Median $6.61 Typical High $6.61 | Professional | 55 · Aftercare only | $6.31 | $6.61 | $6.61 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.27 Median $4.47 Typical High $4.47 | Professional | 56 · Pre-op care only | $4.27 | $4.47 | $4.47 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $21.38 Median $22.39 Typical High $22.39 | Professional | 52 · Reduced service | $21.38 | $22.39 | $22.39 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $8.51 Median $8.91 Typical High $8.91 | Professional | 53 · Discontinued | $8.51 | $8.91 | $8.91 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $6.31 Median $6.61 Typical High $6.61 | Professional | 55 · Aftercare only | $6.31 | $6.61 | $6.61 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.27 Median $4.47 Typical High $4.47 | Professional | 56 · Pre-op care only | $4.27 | $4.47 | $4.47 |
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· 37th of 51
$40.74
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.