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 $53.70 Median $69.18 Typical High $69.18 | Professional | None | $53.70 | $69.18 | $69.18 |
Anthem BCBS Setting Facility Modifier None Typical Low $112.20 Median $144.54 Typical High $269.15 | Facility | None | $112.20 | $144.54 | $269.15 |
Anthem BCBS Setting Professional Modifier None Typical Low $63.10 Median $64.57 Typical High $69.18 | Professional | None | $63.10 | $64.57 | $69.18 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $6.31 Median $6.31 Typical High $6.92 | Professional | RR · Rental | $6.31 | $6.31 | $6.92 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $46.77 Median $46.77 Typical High $52.48 | Professional | UE · Used equipment | $46.77 | $46.77 | $52.48 |
Cigna Setting Facility Modifier None Typical Low $64.57 Median $64.57 Typical High $83.18 | Facility | None | $64.57 | $64.57 | $83.18 |
Cigna Setting Professional Modifier None Typical Low $46.77 Median $46.77 Typical High $64.57 | Professional | None | $46.77 | $46.77 | $64.57 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $44.67 Median $100.00 Typical High $128.82 | Professional | None | $44.67 | $100.00 | $128.82 |
Martin's Point Setting Professional Modifier None Typical Low $61.66 Median $69.18 Typical High $69.18 | Professional | None | $61.66 | $69.18 | $69.18 |
United Setting Professional Modifier None Typical Low $44.67 Median $56.23 Typical High $154.88 | Professional | None | $44.67 | $56.23 | $154.88 |
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 $33.11 Median $34.67 Typical High $34.67 | Professional | 52 · Reduced service | $33.11 | $34.67 | $34.67 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $13.80 Typical High $13.80 | Professional | 53 · Discontinued | $13.18 | $13.80 | $13.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $10.23 Typical High $10.23 | Professional | 55 · Aftercare only | $9.77 | $10.23 | $10.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $6.92 Typical High $6.92 | Professional | 56 · Pre-op care only | $6.61 | $6.92 | $6.92 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $33.11 Median $34.67 Typical High $34.67 | Professional | 52 · Reduced service | $33.11 | $34.67 | $34.67 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $13.80 Typical High $13.80 | Professional | 53 · Discontinued | $13.18 | $13.80 | $13.80 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $10.23 Typical High $10.23 | Professional | 55 · Aftercare only | $9.77 | $10.23 | $10.23 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $6.92 Typical High $6.92 | Professional | 56 · Pre-op care only | $6.61 | $6.92 | $6.92 |
Where Maine sits
The same service costs 2.6 times more in Hawaii 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· 28th of 51
$64.57
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.