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 $11.22 Median $11.22 Typical High $11.22 | Professional | None | $11.22 | $11.22 | $11.22 |
Anthem BCBS Setting Professional Modifier None Typical Low $16.22 Median $19.95 Typical High $20.89 | Professional | None | $16.22 | $19.95 | $20.89 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.51 Median $2.00 Typical High $2.00 | Professional | RR · Rental | $1.51 | $2.00 | $2.00 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $11.22 Median $15.14 Typical High $15.14 | Professional | UE · Used equipment | $11.22 | $15.14 | $15.14 |
Cigna Setting Professional Modifier None Typical Low $8.13 Median $8.13 Typical High $8.13 | Professional | None | $8.13 | $8.13 | $8.13 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $9.33 Median $17.38 Typical High $17.78 | Professional | None | $9.33 | $17.38 | $17.78 |
Martin's Point Setting Professional Modifier None Typical Low $11.22 Median $11.22 Typical High $11.22 | Professional | None | $11.22 | $11.22 | $11.22 |
United Setting Professional Modifier None Typical Low $7.76 Median $9.77 Typical High $22.39 | Professional | None | $7.76 | $9.77 | $22.39 |
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 $5.62 Median $5.62 Typical High $5.62 | Professional | 52 · Reduced service | $5.62 | $5.62 | $5.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | 53 · Discontinued | $2.24 | $2.24 | $2.24 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $8.51 Median $8.51 Typical High $8.51 | Professional | 54 · Surgery only | $8.51 | $8.51 | $8.51 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.70 Median $1.70 Typical High $1.70 | Professional | 55 · Aftercare only | $1.70 | $1.70 | $1.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.12 Median $1.12 Typical High $1.12 | Professional | 56 · Pre-op care only | $1.12 | $1.12 | $1.12 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $5.62 Median $5.62 Typical High $5.62 | Professional | 52 · Reduced service | $5.62 | $5.62 | $5.62 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | 53 · Discontinued | $2.24 | $2.24 | $2.24 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $8.51 Median $8.51 Typical High $8.51 | Professional | 54 · Surgery only | $8.51 | $8.51 | $8.51 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.70 Median $1.70 Typical High $1.70 | Professional | 55 · Aftercare only | $1.70 | $1.70 | $1.70 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.12 Median $1.12 Typical High $1.12 | Professional | 56 · Pre-op care only | $1.12 | $1.12 | $1.12 |
Where Maine sits
The same service costs 2.8 times more in Hawaii 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· 22nd of 51
$14.45
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.