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 $3.39 Median $4.07 Typical High $4.07 | Professional | None | $3.39 | $4.07 | $4.07 |
Anthem BCBS Setting Facility Modifier None Typical Low $6.03 Median $7.76 Typical High $14.79 | Facility | None | $6.03 | $7.76 | $14.79 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.39 Median $3.55 Typical High $3.72 | Professional | None | $3.39 | $3.55 | $3.72 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.34 Median $0.34 Typical High $0.37 | Professional | RR · Rental | $0.34 | $0.34 | $0.37 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $2.57 Median $2.57 Typical High $2.82 | Professional | UE · Used equipment | $2.57 | $2.57 | $2.82 |
Cigna Setting Facility Modifier None Typical Low $3.55 Median $3.55 Typical High $3.80 | Facility | None | $3.55 | $3.55 | $3.80 |
Cigna Setting Professional Modifier None Typical Low $2.95 Median $2.95 Typical High $3.55 | Professional | None | $2.95 | $2.95 | $3.55 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2.40 Median $5.37 Typical High $7.08 | Professional | None | $2.40 | $5.37 | $7.08 |
Martin's Point Setting Professional Modifier None Typical Low $3.39 Median $4.07 Typical High $4.07 | Professional | None | $3.39 | $4.07 | $4.07 |
United Setting Professional Modifier None Typical Low $2.40 Median $3.02 Typical High $8.51 | Professional | None | $2.40 | $3.02 | $8.51 |
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 $1.70 Median $2.04 Typical High $2.04 | Professional | 52 · Reduced service | $1.70 | $2.04 | $2.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.68 Median $0.81 Typical High $0.81 | Professional | 53 · Discontinued | $0.68 | $0.81 | $0.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.51 Median $0.62 Typical High $0.62 | Professional | 55 · Aftercare only | $0.51 | $0.62 | $0.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.34 Median $0.41 Typical High $0.41 | Professional | 56 · Pre-op care only | $0.34 | $0.41 | $0.41 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.70 Median $2.04 Typical High $2.04 | Professional | 52 · Reduced service | $1.70 | $2.04 | $2.04 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.68 Median $0.81 Typical High $0.81 | Professional | 53 · Discontinued | $0.68 | $0.81 | $0.81 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.51 Median $0.62 Typical High $0.62 | Professional | 55 · Aftercare only | $0.51 | $0.62 | $0.62 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.34 Median $0.41 Typical High $0.41 | Professional | 56 · Pre-op care only | $0.34 | $0.41 | $0.41 |
Where Maine sits
The same service costs 4.9 times more in Kansas 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· 35th of 51
$3.55
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.