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 $61.66 Median $74.13 Typical High $74.13 | Professional | None | $61.66 | $74.13 | $74.13 |
Anthem BCBS Setting Facility Modifier None Typical Low $109.65 Median $141.25 Typical High $269.15 | Facility | None | $109.65 | $141.25 | $269.15 |
Anthem BCBS Setting Professional Modifier None Typical Low $61.66 Median $61.66 Typical High $67.61 | Professional | None | $61.66 | $61.66 | $67.61 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $6.17 Median $6.17 Typical High $6.76 | Professional | RR · Rental | $6.17 | $6.17 | $6.76 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $45.71 Median $45.71 Typical High $50.12 | Professional | UE · Used equipment | $45.71 | $45.71 | $50.12 |
Cigna Setting Facility Modifier None Typical Low $91.20 Median $91.20 Typical High $97.72 | Facility | None | $91.20 | $91.20 | $97.72 |
Cigna Setting Professional Modifier None Typical Low $77.62 Median $77.62 Typical High $91.20 | Professional | None | $77.62 | $77.62 | $91.20 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $43.65 Median $97.72 Typical High $128.82 | Professional | None | $43.65 | $97.72 | $128.82 |
Martin's Point Setting Professional Modifier None Typical Low $61.66 Median $74.13 Typical High $74.13 | Professional | None | $61.66 | $74.13 | $74.13 |
United Setting Professional Modifier None Typical Low $43.65 Median $54.95 Typical High $154.88 | Professional | None | $43.65 | $54.95 | $154.88 |
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 $30.20 Median $37.15 Typical High $37.15 | Professional | 52 · Reduced service | $30.20 | $37.15 | $37.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.30 Median $15.14 Typical High $15.14 | Professional | 53 · Discontinued | $12.30 | $15.14 | $15.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.12 Median $11.22 Typical High $11.22 | Professional | 55 · Aftercare only | $9.12 | $11.22 | $11.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.17 Median $7.41 Typical High $7.41 | Professional | 56 · Pre-op care only | $6.17 | $7.41 | $7.41 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $30.20 Median $37.15 Typical High $37.15 | Professional | 52 · Reduced service | $30.20 | $37.15 | $37.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $12.30 Median $15.14 Typical High $15.14 | Professional | 53 · Discontinued | $12.30 | $15.14 | $15.14 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $9.12 Median $11.22 Typical High $11.22 | Professional | 55 · Aftercare only | $9.12 | $11.22 | $11.22 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.17 Median $7.41 Typical High $7.41 | Professional | 56 · Pre-op care only | $6.17 | $7.41 | $7.41 |
Where Maine sits
The same service costs 1.9 times more in Montana than in Virginia. 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· 37th of 51
$74.13
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.