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 $3.24 Median $3.24 Typical High $3.24 | Professional | None | $3.24 | $3.24 | $3.24 |
Anthem BCBS Setting Professional Modifier None Typical Low $4.90 Median $5.75 Typical High $6.31 | Professional | None | $4.90 | $5.75 | $6.31 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.43 Median $0.58 Typical High $0.58 | Professional | RR · Rental | $0.43 | $0.58 | $0.58 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $3.24 Median $4.37 Typical High $4.37 | Professional | UE · Used equipment | $3.24 | $4.37 | $4.37 |
Cigna Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2.69 Median $5.01 Typical High $5.25 | Professional | None | $2.69 | $5.01 | $5.25 |
Martin's Point Setting Professional Modifier None Typical Low $3.24 Median $3.24 Typical High $3.24 | Professional | None | $3.24 | $3.24 | $3.24 |
United Setting Professional Modifier None Typical Low $2.24 Median $2.82 Typical High $6.61 | Professional | None | $2.24 | $2.82 | $6.61 |
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 $1.62 Median $1.62 Typical High $1.62 | Professional | 52 · Reduced service | $1.62 | $1.62 | $1.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.65 Median $0.65 Typical High $0.65 | Professional | 53 · Discontinued | $0.65 | $0.65 | $0.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.45 Median $2.45 Typical High $2.45 | Professional | 54 · Surgery only | $2.45 | $2.45 | $2.45 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.49 Median $0.49 Typical High $0.49 | Professional | 55 · Aftercare only | $0.49 | $0.49 | $0.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.33 Median $0.33 Typical High $0.33 | Professional | 56 · Pre-op care only | $0.33 | $0.33 | $0.33 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.62 Median $1.62 Typical High $1.62 | Professional | 52 · Reduced service | $1.62 | $1.62 | $1.62 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.65 Median $0.65 Typical High $0.65 | Professional | 53 · Discontinued | $0.65 | $0.65 | $0.65 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2.45 Median $2.45 Typical High $2.45 | Professional | 54 · Surgery only | $2.45 | $2.45 | $2.45 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.49 Median $0.49 Typical High $0.49 | Professional | 55 · Aftercare only | $0.49 | $0.49 | $0.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.33 Median $0.33 Typical High $0.33 | Professional | 56 · Pre-op care only | $0.33 | $0.33 | $0.33 |
Where Maine sits
The same service costs 3.0 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· 15th of 51
$4.68
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.