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 $11.75 Median $16.98 Typical High $16.98 | Professional | None | $11.75 | $16.98 | $16.98 |
Anthem BCBS Setting Facility Modifier None Typical Low $24.55 Median $31.62 Typical High $60.26 | Facility | None | $24.55 | $31.62 | $60.26 |
Anthem BCBS Setting Professional Modifier None Typical Low $17.78 Median $18.62 Typical High $19.95 | Professional | None | $17.78 | $18.62 | $19.95 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.82 Median $1.82 Typical High $2.00 | Professional | RR · Rental | $1.82 | $1.82 | $2.00 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $13.49 Median $13.49 Typical High $14.79 | Professional | UE · Used equipment | $13.49 | $13.49 | $14.79 |
Cigna Setting Facility Modifier None Typical Low $16.22 Median $16.22 Typical High $18.20 | Facility | None | $16.22 | $16.22 | $18.20 |
Cigna Setting Professional Modifier None Typical Low $12.02 Median $12.02 Typical High $16.22 | Professional | None | $12.02 | $12.02 | $16.22 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $9.77 Median $21.88 Typical High $28.84 | Professional | None | $9.77 | $21.88 | $28.84 |
Martin's Point Setting Professional Modifier None Typical Low $11.75 Median $16.98 Typical High $16.98 | Professional | None | $11.75 | $16.98 | $16.98 |
United Setting Facility Modifier None Typical Low $12.88 Median $12.88 Typical High $15.49 | Facility | None | $12.88 | $12.88 | $15.49 |
United Setting Professional Modifier None Typical Low $9.77 Median $12.59 Typical High $34.67 | Professional | None | $9.77 | $12.59 | $34.67 |
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 $7.08 Median $8.32 Typical High $8.32 | Professional | 52 · Reduced service | $7.08 | $8.32 | $8.32 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.82 Median $3.39 Typical High $3.39 | Professional | 53 · Discontinued | $2.82 | $3.39 | $3.39 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.09 Median $2.51 Typical High $2.51 | Professional | 55 · Aftercare only | $2.09 | $2.51 | $2.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.41 Median $1.70 Typical High $1.70 | Professional | 56 · Pre-op care only | $1.41 | $1.70 | $1.70 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $7.08 Median $8.32 Typical High $8.32 | Professional | 52 · Reduced service | $7.08 | $8.32 | $8.32 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.82 Median $3.39 Typical High $3.39 | Professional | 53 · Discontinued | $2.82 | $3.39 | $3.39 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.09 Median $2.51 Typical High $2.51 | Professional | 55 · Aftercare only | $2.09 | $2.51 | $2.51 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.41 Median $1.70 Typical High $1.70 | Professional | 56 · Pre-op care only | $1.41 | $1.70 | $1.70 |
Where Maine sits
The same service costs 3.0 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· 26th of 51
$17.78
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.