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 $4.79 Median $5.37 Typical High $5.37 | Professional | None | $4.79 | $5.37 | $5.37 |
Anthem BCBS Setting Facility Modifier None Typical Low $7.94 Median $10.23 Typical High $19.05 | Facility | None | $7.94 | $10.23 | $19.05 |
Anthem BCBS Setting Professional Modifier None Typical Low $4.90 Median $5.01 Typical High $5.37 | Professional | None | $4.90 | $5.01 | $5.37 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.49 Median $0.49 Typical High $0.52 | Professional | RR · Rental | $0.49 | $0.49 | $0.52 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $3.63 Median $3.63 Typical High $3.98 | Professional | UE · Used equipment | $3.63 | $3.63 | $3.98 |
Cigna Setting Facility Modifier None Typical Low $5.13 Median $5.13 Typical High $5.89 | Facility | None | $5.13 | $5.13 | $5.89 |
Cigna Setting Professional Modifier None Typical Low $3.80 Median $3.80 Typical High $5.13 | Professional | None | $3.80 | $3.80 | $5.13 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $3.31 Median $7.08 Typical High $9.12 | Professional | None | $3.31 | $7.08 | $9.12 |
Martin's Point Setting Professional Modifier None Typical Low $4.79 Median $5.37 Typical High $5.37 | Professional | None | $4.79 | $5.37 | $5.37 |
United Setting Facility Modifier None Typical Low $4.79 Median $4.79 Typical High $5.37 | Facility | None | $4.79 | $4.79 | $5.37 |
United Setting Professional Modifier None Typical Low $3.16 Median $3.98 Typical High $11.22 | Professional | None | $3.16 | $3.98 | $11.22 |
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 $2.51 Median $2.69 Typical High $2.69 | Professional | 52 · Reduced service | $2.51 | $2.69 | $2.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.00 Median $1.07 Typical High $1.07 | Professional | 53 · Discontinued | $1.00 | $1.07 | $1.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.76 Median $0.81 Typical High $0.81 | Professional | 55 · Aftercare only | $0.76 | $0.81 | $0.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.51 Median $0.54 Typical High $0.54 | Professional | 56 · Pre-op care only | $0.51 | $0.54 | $0.54 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2.51 Median $2.69 Typical High $2.69 | Professional | 52 · Reduced service | $2.51 | $2.69 | $2.69 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $1.00 Median $1.07 Typical High $1.07 | Professional | 53 · Discontinued | $1.00 | $1.07 | $1.07 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.76 Median $0.81 Typical High $0.81 | Professional | 55 · Aftercare only | $0.76 | $0.81 | $0.81 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.51 Median $0.54 Typical High $0.54 | Professional | 56 · Pre-op care only | $0.51 | $0.54 | $0.54 |
Where Maine sits
The same service costs 3.2 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· 33rd of 51
$5.01
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.