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 $10.23 Median $10.23 Typical High $10.23 | Professional | None | $10.23 | $10.23 | $10.23 |
Anthem BCBS Setting Professional Modifier None Typical Low $14.79 Median $18.20 Typical High $19.05 | Professional | None | $14.79 | $18.20 | $19.05 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.38 Median $1.82 Typical High $1.82 | Professional | RR · Rental | $1.38 | $1.82 | $1.82 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $10.23 Median $13.80 Typical High $13.80 | Professional | UE · Used equipment | $10.23 | $13.80 | $13.80 |
Cigna Setting Professional Modifier None Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | None | $7.59 | $7.59 | $7.59 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $8.51 Median $15.85 Typical High $16.22 | Professional | None | $8.51 | $15.85 | $16.22 |
Martin's Point Setting Professional Modifier None Typical Low $10.23 Median $10.23 Typical High $10.23 | Professional | None | $10.23 | $10.23 | $10.23 |
United Setting Professional Modifier None Typical Low $7.08 Median $8.91 Typical High $20.89 | Professional | None | $7.08 | $8.91 | $20.89 |
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 $5.13 Median $5.13 Typical High $5.13 | Professional | 52 · Reduced service | $5.13 | $5.13 | $5.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.04 Median $2.04 Typical High $2.04 | Professional | 53 · Discontinued | $2.04 | $2.04 | $2.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $7.76 Median $7.76 Typical High $7.76 | Professional | 54 · Surgery only | $7.76 | $7.76 | $7.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.55 Median $1.55 Typical High $1.55 | Professional | 55 · Aftercare only | $1.55 | $1.55 | $1.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.02 Median $1.02 Typical High $1.02 | Professional | 56 · Pre-op care only | $1.02 | $1.02 | $1.02 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $5.13 Median $5.13 Typical High $5.13 | Professional | 52 · Reduced service | $5.13 | $5.13 | $5.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.04 Median $2.04 Typical High $2.04 | Professional | 53 · Discontinued | $2.04 | $2.04 | $2.04 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $7.76 Median $7.76 Typical High $7.76 | Professional | 54 · Surgery only | $7.76 | $7.76 | $7.76 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.55 Median $1.55 Typical High $1.55 | Professional | 55 · Aftercare only | $1.55 | $1.55 | $1.55 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.02 Median $1.02 Typical High $1.02 | Professional | 56 · Pre-op care only | $1.02 | $1.02 | $1.02 |
Where Maine sits
The same service costs 2.7 times more in Idaho 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· 23rd of 51
$13.18
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.