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 $6.61 Median $9.33 Typical High $9.33 | Professional | None | $6.61 | $9.33 | $9.33 |
Anthem BCBS Setting Facility Modifier None Typical Low $13.80 Median $17.78 Typical High $33.88 | Facility | None | $13.80 | $17.78 | $33.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $6.61 Median $6.92 Typical High $7.41 | Professional | None | $6.61 | $6.92 | $7.41 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.68 Median $0.68 Typical High $0.72 | Professional | RR · Rental | $0.68 | $0.68 | $0.72 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $5.01 Median $5.01 Typical High $5.50 | Professional | UE · Used equipment | $5.01 | $5.01 | $5.50 |
Cigna Setting Facility Modifier None Typical Low $7.08 Median $7.08 Typical High $10.23 | Facility | None | $7.08 | $7.08 | $10.23 |
Cigna Setting Professional Modifier None Typical Low $5.25 Median $5.25 Typical High $7.08 | Professional | None | $5.25 | $5.25 | $7.08 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $5.50 Median $12.30 Typical High $16.22 | Professional | None | $5.50 | $12.30 | $16.22 |
Martin's Point Setting Professional Modifier None Typical Low $6.61 Median $9.33 Typical High $9.33 | Professional | None | $6.61 | $9.33 | $9.33 |
United Setting Facility Modifier None Typical Low $6.31 Median $6.31 Typical High $7.94 | Facility | None | $6.31 | $6.31 | $7.94 |
United Setting Professional Modifier None Typical Low $5.13 Median $6.92 Typical High $19.50 | Professional | None | $5.13 | $6.92 | $19.50 |
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 $3.47 Median $4.68 Typical High $4.68 | Professional | 52 · Reduced service | $3.47 | $4.68 | $4.68 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.38 Median $1.91 Typical High $1.91 | Professional | 53 · Discontinued | $1.38 | $1.91 | $1.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.05 Median $1.41 Typical High $1.41 | Professional | 55 · Aftercare only | $1.05 | $1.41 | $1.41 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.71 Median $0.93 Typical High $0.93 | Professional | 56 · Pre-op care only | $0.71 | $0.93 | $0.93 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $3.47 Median $4.68 Typical High $4.68 | Professional | 52 · Reduced service | $3.47 | $4.68 | $4.68 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $1.38 Median $1.91 Typical High $1.91 | Professional | 53 · Discontinued | $1.38 | $1.91 | $1.91 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.05 Median $1.41 Typical High $1.41 | Professional | 55 · Aftercare only | $1.05 | $1.41 | $1.41 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.71 Median $0.93 Typical High $0.93 | Professional | 56 · Pre-op care only | $0.71 | $0.93 | $0.93 |
Where Maine sits
The same service costs 3.5 times more in Montana than in Kansas. 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· 35th of 51
$6.92
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.