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 $13.49 Median $13.49 Typical High $13.49 | Professional | None | $13.49 | $13.49 | $13.49 |
Anthem BCBS Setting Professional Modifier None Typical Low $19.50 Median $23.99 Typical High $25.12 | Professional | None | $19.50 | $23.99 | $25.12 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.82 Median $2.40 Typical High $2.40 | Professional | RR · Rental | $1.82 | $2.40 | $2.40 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $13.49 Median $18.20 Typical High $18.20 | Professional | UE · Used equipment | $13.49 | $18.20 | $18.20 |
Cigna Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $9.77 | Professional | None | $9.77 | $9.77 | $9.77 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $11.22 Median $20.89 Typical High $20.89 | Professional | None | $11.22 | $20.89 | $20.89 |
Martin's Point Setting Professional Modifier None Typical Low $13.49 Median $13.49 Typical High $13.49 | Professional | None | $13.49 | $13.49 | $13.49 |
United Setting Professional Modifier None Typical Low $9.12 Median $11.75 Typical High $26.92 | Professional | None | $9.12 | $11.75 | $26.92 |
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 $6.76 Median $6.76 Typical High $6.76 | Professional | 52 · Reduced service | $6.76 | $6.76 | $6.76 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.69 Median $2.69 Typical High $2.69 | Professional | 53 · Discontinued | $2.69 | $2.69 | $2.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.23 Median $10.23 Typical High $10.23 | Professional | 54 · Surgery only | $10.23 | $10.23 | $10.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.04 Median $2.04 Typical High $2.04 | Professional | 55 · Aftercare only | $2.04 | $2.04 | $2.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.35 Median $1.35 Typical High $1.35 | Professional | 56 · Pre-op care only | $1.35 | $1.35 | $1.35 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $6.76 Median $6.76 Typical High $6.76 | Professional | 52 · Reduced service | $6.76 | $6.76 | $6.76 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.69 Median $2.69 Typical High $2.69 | Professional | 53 · Discontinued | $2.69 | $2.69 | $2.69 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $10.23 Median $10.23 Typical High $10.23 | Professional | 54 · Surgery only | $10.23 | $10.23 | $10.23 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.04 Median $2.04 Typical High $2.04 | Professional | 55 · Aftercare only | $2.04 | $2.04 | $2.04 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.35 Median $1.35 Typical High $1.35 | Professional | 56 · Pre-op care only | $1.35 | $1.35 | $1.35 |
Where Maine sits
The same service costs 3.2 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
$18.62
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.