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 $3.09 Median $3.09 Typical High $3.98 | Professional | None | $3.09 | $3.09 | $3.98 |
Anthem BCBS Setting Professional Modifier None Typical Low $4.07 Median $5.50 Typical High $5.50 | Professional | None | $4.07 | $5.50 | $5.50 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.41 Median $0.55 Typical High $0.55 | Professional | RR · Rental | $0.41 | $0.55 | $0.55 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $3.09 Median $4.17 Typical High $4.17 | Professional | UE · Used equipment | $3.09 | $4.17 | $4.17 |
Cigna Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | None | $2.24 | $2.24 | $2.24 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2.57 Median $4.68 Typical High $4.79 | Professional | None | $2.57 | $4.68 | $4.79 |
Martin's Point Setting Professional Modifier None Typical Low $3.09 Median $3.09 Typical High $3.98 | Professional | None | $3.09 | $3.09 | $3.98 |
United Setting Professional Modifier None Typical Low $2.09 Median $2.69 Typical High $6.17 | Professional | None | $2.09 | $2.69 | $6.17 |
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 $1.55 Median $1.55 Typical High $1.55 | Professional | 52 · Reduced service | $1.55 | $1.55 | $1.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.62 Median $0.62 Typical High $0.62 | Professional | 53 · Discontinued | $0.62 | $0.62 | $0.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.29 Median $2.29 Typical High $2.29 | Professional | 54 · Surgery only | $2.29 | $2.29 | $2.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.46 Median $0.46 Typical High $0.46 | Professional | 55 · Aftercare only | $0.46 | $0.46 | $0.46 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.31 Median $0.31 Typical High $0.31 | Professional | 56 · Pre-op care only | $0.31 | $0.31 | $0.31 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.55 Median $1.55 Typical High $1.55 | Professional | 52 · Reduced service | $1.55 | $1.55 | $1.55 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.62 Median $0.62 Typical High $0.62 | Professional | 53 · Discontinued | $0.62 | $0.62 | $0.62 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2.29 Median $2.29 Typical High $2.29 | Professional | 54 · Surgery only | $2.29 | $2.29 | $2.29 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.46 Median $0.46 Typical High $0.46 | Professional | 55 · Aftercare only | $0.46 | $0.46 | $0.46 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.31 Median $0.31 Typical High $0.31 | Professional | 56 · Pre-op care only | $0.31 | $0.31 | $0.31 |
Where Maine sits
The same service costs 3.8 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· 21st of 51
$4.07
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.