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 $0.63 Median $0.63 Typical High $0.63 | Professional | None | $0.63 | $0.63 | $0.63 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.48 Median $0.49 Typical High $0.52 | Professional | None | $0.48 | $0.49 | $0.52 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.27 Median $0.36 Typical High $0.48 | Professional | UE · Used equipment | $0.27 | $0.36 | $0.48 |
Cigna Setting Professional Modifier None Typical Low $0.55 Median $0.55 Typical High $0.55 | Professional | None | $0.55 | $0.55 | $0.55 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $0.48 Median $0.95 Typical High $0.95 | Professional | None | $0.48 | $0.95 | $0.95 |
Martin's Point Setting Professional Modifier None Typical Low $0.63 Median $0.63 Typical High $0.63 | Professional | None | $0.63 | $0.63 | $0.63 |
United Setting Professional Modifier None Typical Low $0.43 Median $0.52 Typical High $1.26 | Professional | None | $0.43 | $0.52 | $1.26 |
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 $0.32 Median $0.32 Typical High $0.32 | Professional | 52 · Reduced service | $0.32 | $0.32 | $0.32 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.13 Median $0.13 Typical High $0.13 | Professional | 53 · Discontinued | $0.13 | $0.13 | $0.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.09 Median $0.09 Typical High $0.09 | Professional | 55 · Aftercare only | $0.09 | $0.09 | $0.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.06 Median $0.06 Typical High $0.06 | Professional | 56 · Pre-op care only | $0.06 | $0.06 | $0.06 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $0.32 Median $0.32 Typical High $0.32 | Professional | 52 · Reduced service | $0.32 | $0.32 | $0.32 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.13 Median $0.13 Typical High $0.13 | Professional | 53 · Discontinued | $0.13 | $0.13 | $0.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.09 Median $0.09 Typical High $0.09 | Professional | 55 · Aftercare only | $0.09 | $0.09 | $0.09 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.06 Median $0.06 Typical High $0.06 | Professional | 56 · Pre-op care only | $0.06 | $0.06 | $0.06 |
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· 38th of 51
$0.55
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.