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 $14.79 Median $19.50 Typical High $19.50 | Professional | None | $14.79 | $19.50 | $19.50 |
Anthem BCBS Setting Facility Modifier None Typical Low $28.84 Median $37.15 Typical High $70.79 | Facility | None | $28.84 | $37.15 | $70.79 |
Anthem BCBS Setting Professional Modifier None Typical Low $19.95 Median $20.42 Typical High $21.88 | Professional | None | $19.95 | $20.42 | $21.88 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $2.00 Median $2.00 Typical High $2.19 | Professional | RR · Rental | $2.00 | $2.00 | $2.19 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $14.79 Median $14.79 Typical High $16.22 | Professional | UE · Used equipment | $14.79 | $14.79 | $16.22 |
Cigna Setting Facility Modifier None Typical Low $18.62 Median $18.62 Typical High $21.38 | Facility | None | $18.62 | $18.62 | $21.38 |
Cigna Setting Professional Modifier None Typical Low $13.49 Median $13.49 Typical High $18.62 | Professional | None | $13.49 | $13.49 | $18.62 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $11.48 Median $25.70 Typical High $33.88 | Professional | None | $11.48 | $25.70 | $33.88 |
Martin's Point Setting Professional Modifier None Typical Low $14.79 Median $19.50 Typical High $19.50 | Professional | None | $14.79 | $19.50 | $19.50 |
United Setting Facility Modifier None Typical Low $14.45 Median $14.45 Typical High $16.60 | Facility | None | $14.45 | $14.45 | $16.60 |
United Setting Professional Modifier None Typical Low $11.48 Median $14.45 Typical High $40.74 | Professional | None | $11.48 | $14.45 | $40.74 |
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 $7.94 Median $9.77 Typical High $9.77 | Professional | 52 · Reduced service | $7.94 | $9.77 | $9.77 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.16 Median $3.98 Typical High $3.98 | Professional | 53 · Discontinued | $3.16 | $3.98 | $3.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.40 Median $2.95 Typical High $2.95 | Professional | 55 · Aftercare only | $2.40 | $2.95 | $2.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.58 Median $1.95 Typical High $1.95 | Professional | 56 · Pre-op care only | $1.58 | $1.95 | $1.95 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $7.94 Median $9.77 Typical High $9.77 | Professional | 52 · Reduced service | $7.94 | $9.77 | $9.77 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $3.16 Median $3.98 Typical High $3.98 | Professional | 53 · Discontinued | $3.16 | $3.98 | $3.98 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.40 Median $2.95 Typical High $2.95 | Professional | 55 · Aftercare only | $2.40 | $2.95 | $2.95 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.58 Median $1.95 Typical High $1.95 | Professional | 56 · Pre-op care only | $1.58 | $1.95 | $1.95 |
Where Maine sits
The same service costs 2.8 times more in Hawaii than in Pennsylvania. 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· 25th 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.