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 $16.98 Median $20.89 Typical High $20.89 | Professional | None | $16.98 | $20.89 | $20.89 |
Anthem BCBS Setting Facility Modifier None Typical Low $30.20 Median $38.90 Typical High $74.13 | Facility | None | $30.20 | $38.90 | $74.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $25.12 Median $25.12 Typical High $25.70 | Professional | None | $25.12 | $25.12 | $25.70 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $2.24 Median $2.51 Typical High $2.75 | Professional | RR · Rental | $2.24 | $2.51 | $2.75 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $16.98 Median $18.62 Typical High $20.42 | Professional | UE · Used equipment | $16.98 | $18.62 | $20.42 |
Cigna Setting Facility Modifier None Typical Low $25.12 Median $25.12 Typical High $26.92 | Facility | None | $25.12 | $25.12 | $26.92 |
Cigna Setting Professional Modifier None Typical Low $21.38 Median $21.38 Typical High $25.12 | Professional | None | $21.38 | $21.38 | $25.12 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $12.02 Median $26.92 Typical High $35.48 | Professional | None | $12.02 | $26.92 | $35.48 |
Martin's Point Setting Professional Modifier None Typical Low $16.98 Median $20.89 Typical High $20.89 | Professional | None | $16.98 | $20.89 | $20.89 |
United Setting Professional Modifier None Typical Low $12.02 Median $15.49 Typical High $42.66 | Professional | None | $12.02 | $15.49 | $42.66 |
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 $8.51 Median $10.47 Typical High $10.47 | Professional | 52 · Reduced service | $8.51 | $10.47 | $10.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.39 Median $4.17 Typical High $4.17 | Professional | 53 · Discontinued | $3.39 | $4.17 | $4.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.51 Median $3.09 Typical High $3.09 | Professional | 55 · Aftercare only | $2.51 | $3.09 | $3.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.70 Median $2.09 Typical High $2.09 | Professional | 56 · Pre-op care only | $1.70 | $2.09 | $2.09 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $8.51 Median $10.47 Typical High $10.47 | Professional | 52 · Reduced service | $8.51 | $10.47 | $10.47 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $3.39 Median $4.17 Typical High $4.17 | Professional | 53 · Discontinued | $3.39 | $4.17 | $4.17 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.51 Median $3.09 Typical High $3.09 | Professional | 55 · Aftercare only | $2.51 | $3.09 | $3.09 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.70 Median $2.09 Typical High $2.09 | Professional | 56 · Pre-op care only | $1.70 | $2.09 | $2.09 |
Where Maine sits
The same service costs 2.1 times more in Minnesota than in Washington, DC. 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· 18th of 51
$25.12
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.