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 $0.32 Median $0.32 Typical High $0.32 | Professional | None | $0.32 | $0.32 | $0.32 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.25 Median $0.26 Typical High $0.27 | Professional | None | $0.25 | $0.26 | $0.27 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.14 Median $0.19 Typical High $0.25 | Professional | UE · Used equipment | $0.14 | $0.19 | $0.25 |
Cigna Setting Professional Modifier None Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | None | $0.28 | $0.28 | $0.28 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $0.27 Median $0.47 Typical High $0.48 | Professional | None | $0.27 | $0.47 | $0.48 |
Martin's Point Setting Professional Modifier None Typical Low $0.32 Median $0.32 Typical High $0.32 | Professional | None | $0.32 | $0.32 | $0.32 |
United Setting Professional Modifier None Typical Low $0.21 Median $0.28 Typical High $0.65 | Professional | None | $0.21 | $0.28 | $0.65 |
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 $0.16 Median $0.16 Typical High $0.16 | Professional | 52 · Reduced service | $0.16 | $0.16 | $0.16 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.06 Median $0.06 Typical High $0.06 | Professional | 53 · Discontinued | $0.06 | $0.06 | $0.06 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | 56 · Pre-op care only | $0.03 | $0.03 | $0.03 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $0.16 Median $0.16 Typical High $0.16 | Professional | 52 · Reduced service | $0.16 | $0.16 | $0.16 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.06 Median $0.06 Typical High $0.06 | Professional | 53 · Discontinued | $0.06 | $0.06 | $0.06 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.05 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | 56 · Pre-op care only | $0.03 | $0.03 | $0.03 |
Where Maine sits
The same service costs 2.6 times more in Hawaii than in Utah. 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· 34th of 51
$0.32
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.