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 $2.45 Median $2.45 Typical High $2.45 | Professional | None | $2.45 | $2.45 | $2.45 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.55 Median $4.27 Typical High $4.47 | Professional | None | $3.55 | $4.27 | $4.47 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.32 Median $0.43 Typical High $0.43 | Professional | RR · Rental | $0.32 | $0.43 | $0.43 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $2.40 Median $3.24 Typical High $3.24 | Professional | UE · Used equipment | $2.40 | $3.24 | $3.24 |
Cigna Setting Professional Modifier None Typical Low $1.78 Median $1.78 Typical High $1.78 | Professional | None | $1.78 | $1.78 | $1.78 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2.00 Median $3.72 Typical High $3.80 | Professional | None | $2.00 | $3.72 | $3.80 |
Martin's Point Setting Professional Modifier None Typical Low $2.45 Median $2.45 Typical High $2.45 | Professional | None | $2.45 | $2.45 | $2.45 |
United Setting Professional Modifier None Typical Low $1.66 Median $2.09 Typical High $4.90 | Professional | None | $1.66 | $2.09 | $4.90 |
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 $1.23 Median $1.23 Typical High $1.23 | Professional | 52 · Reduced service | $1.23 | $1.23 | $1.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.49 Median $0.49 Typical High $0.49 | Professional | 53 · Discontinued | $0.49 | $0.49 | $0.49 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1.82 Median $1.82 Typical High $1.82 | Professional | 54 · Surgery only | $1.82 | $1.82 | $1.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.36 Median $0.36 Typical High $0.36 | Professional | 55 · Aftercare only | $0.36 | $0.36 | $0.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.24 Median $0.24 Typical High $0.24 | Professional | 56 · Pre-op care only | $0.24 | $0.24 | $0.24 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.23 Median $1.23 Typical High $1.23 | Professional | 52 · Reduced service | $1.23 | $1.23 | $1.23 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.49 Median $0.49 Typical High $0.49 | Professional | 53 · Discontinued | $0.49 | $0.49 | $0.49 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1.82 Median $1.82 Typical High $1.82 | Professional | 54 · Surgery only | $1.82 | $1.82 | $1.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.36 Median $0.36 Typical High $0.36 | Professional | 55 · Aftercare only | $0.36 | $0.36 | $0.36 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.24 Median $0.24 Typical High $0.24 | Professional | 56 · Pre-op care only | $0.24 | $0.24 | $0.24 |
Where Maine sits
The same service costs 4.0 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· 19th of 51
$3.39
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.