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 $4.79 Median $4.79 Typical High $7.94 | Professional | None | $4.79 | $4.79 | $7.94 |
Anthem BCBS Setting Professional Modifier None Typical Low $6.92 Median $8.51 Typical High $8.91 | Professional | None | $6.92 | $8.51 | $8.91 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.65 Median $0.85 Typical High $0.85 | Professional | RR · Rental | $0.65 | $0.85 | $0.85 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $4.79 Median $6.46 Typical High $6.46 | Professional | UE · Used equipment | $4.79 | $6.46 | $6.46 |
Cigna Setting Professional Modifier None Typical Low $3.47 Median $3.47 Typical High $3.47 | Professional | None | $3.47 | $3.47 | $3.47 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $3.98 Median $7.41 Typical High $7.59 | Professional | None | $3.98 | $7.41 | $7.59 |
Martin's Point Setting Professional Modifier None Typical Low $4.79 Median $4.79 Typical High $7.94 | Professional | None | $4.79 | $4.79 | $7.94 |
United Setting Professional Modifier None Typical Low $3.31 Median $4.17 Typical High $9.55 | Professional | None | $3.31 | $4.17 | $9.55 |
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 $2.40 Median $2.40 Typical High $2.40 | Professional | 52 · Reduced service | $2.40 | $2.40 | $2.40 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.98 Median $0.98 Typical High $0.98 | Professional | 53 · Discontinued | $0.98 | $0.98 | $0.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.63 Median $3.63 Typical High $3.63 | Professional | 54 · Surgery only | $3.63 | $3.63 | $3.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.72 Median $0.72 Typical High $0.72 | Professional | 55 · Aftercare only | $0.72 | $0.72 | $0.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.48 Median $0.48 Typical High $0.48 | Professional | 56 · Pre-op care only | $0.48 | $0.48 | $0.48 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2.40 Median $2.40 Typical High $2.40 | Professional | 52 · Reduced service | $2.40 | $2.40 | $2.40 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.98 Median $0.98 Typical High $0.98 | Professional | 53 · Discontinued | $0.98 | $0.98 | $0.98 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $3.63 Median $3.63 Typical High $3.63 | Professional | 54 · Surgery only | $3.63 | $3.63 | $3.63 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.72 Median $0.72 Typical High $0.72 | Professional | 55 · Aftercare only | $0.72 | $0.72 | $0.72 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.48 Median $0.48 Typical High $0.48 | Professional | 56 · Pre-op care only | $0.48 | $0.48 | $0.48 |
Where Maine sits
The same service costs 4.1 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· 18th of 51
$6.92
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.