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 $20.89 Median $20.89 Typical High $42.66 | Professional | None | $20.89 | $20.89 | $42.66 |
Anthem BCBS Setting Professional Modifier None Typical Low $30.20 Median $37.15 Typical High $38.90 | Professional | None | $30.20 | $37.15 | $38.90 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $2.82 Median $3.72 Typical High $3.72 | Professional | RR · Rental | $2.82 | $3.72 | $3.72 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $20.89 Median $28.18 Typical High $28.18 | Professional | UE · Used equipment | $20.89 | $28.18 | $28.18 |
Cigna Setting Professional Modifier None Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | None | $15.14 | $15.14 | $15.14 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $17.38 Median $31.62 Typical High $33.11 | Professional | None | $17.38 | $31.62 | $33.11 |
Martin's Point Setting Professional Modifier None Typical Low $20.89 Median $20.89 Typical High $46.77 | Professional | None | $20.89 | $20.89 | $46.77 |
United Setting Professional Modifier None Typical Low $14.13 Median $18.20 Typical High $41.69 | Professional | None | $14.13 | $18.20 | $41.69 |
10 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 $10.47 Median $10.47 Typical High $10.47 | Professional | 52 · Reduced service | $10.47 | $10.47 | $10.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.17 Median $4.17 Typical High $4.17 | Professional | 53 · Discontinued | $4.17 | $4.17 | $4.17 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $15.85 Median $15.85 Typical High $15.85 | Professional | 54 · Surgery only | $15.85 | $15.85 | $15.85 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.16 Median $3.16 Typical High $3.16 | Professional | 55 · Aftercare only | $3.16 | $3.16 | $3.16 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.09 Median $2.09 Typical High $2.09 | Professional | 56 · Pre-op care only | $2.09 | $2.09 | $2.09 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $10.47 Median $10.47 Typical High $10.47 | Professional | 52 · Reduced service | $10.47 | $10.47 | $10.47 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $4.17 Median $4.17 Typical High $4.17 | Professional | 53 · Discontinued | $4.17 | $4.17 | $4.17 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $15.85 Median $15.85 Typical High $15.85 | Professional | 54 · Surgery only | $15.85 | $15.85 | $15.85 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.16 Median $3.16 Typical High $3.16 | Professional | 55 · Aftercare only | $3.16 | $3.16 | $3.16 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.09 Median $2.09 Typical High $2.09 | Professional | 56 · Pre-op care only | $2.09 | $2.09 | $2.09 |
Where Maine sits
The same service costs 3.1 times more in Rhode Island than in New York. 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· 19th of 51
$30.20
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.