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 $9.55 Median $9.55 Typical High $9.55 | Professional | None | $9.55 | $9.55 | $9.55 |
Anthem BCBS Setting Professional Modifier None Typical Low $12.88 Median $16.98 Typical High $16.98 | Professional | None | $12.88 | $16.98 | $16.98 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.29 Median $1.74 Typical High $1.74 | Professional | RR · Rental | $1.29 | $1.74 | $1.74 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $9.55 Median $12.88 Typical High $12.88 | Professional | UE · Used equipment | $9.55 | $12.88 | $12.88 |
Cigna Setting Professional Modifier None Typical Low $7.08 Median $7.08 Typical High $7.08 | Professional | None | $7.08 | $7.08 | $7.08 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $7.94 Median $14.79 Typical High $15.14 | Professional | None | $7.94 | $14.79 | $15.14 |
Martin's Point Setting Professional Modifier None Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | None | $9.55 | $9.55 | $9.55 |
United Setting Professional Modifier None Typical Low $6.61 Median $8.32 Typical High $19.50 | Professional | None | $6.61 | $8.32 | $19.50 |
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 $4.79 Median $4.79 Typical High $4.79 | Professional | 52 · Reduced service | $4.79 | $4.79 | $4.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.95 Median $1.95 Typical High $1.95 | Professional | 53 · Discontinued | $1.95 | $1.95 | $1.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $7.24 Median $7.24 Typical High $7.24 | Professional | 54 · Surgery only | $7.24 | $7.24 | $7.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.45 Median $1.45 Typical High $1.45 | Professional | 55 · Aftercare only | $1.45 | $1.45 | $1.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.98 Median $0.98 Typical High $0.98 | Professional | 56 · Pre-op care only | $0.98 | $0.98 | $0.98 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $4.79 Median $4.79 Typical High $4.79 | Professional | 52 · Reduced service | $4.79 | $4.79 | $4.79 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $1.95 Median $1.95 Typical High $1.95 | Professional | 53 · Discontinued | $1.95 | $1.95 | $1.95 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $7.24 Median $7.24 Typical High $7.24 | Professional | 54 · Surgery only | $7.24 | $7.24 | $7.24 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.45 Median $1.45 Typical High $1.45 | Professional | 55 · Aftercare only | $1.45 | $1.45 | $1.45 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.98 Median $0.98 Typical High $0.98 | Professional | 56 · Pre-op care only | $0.98 | $0.98 | $0.98 |
Where Maine sits
The same service costs 2.8 times more in Hawaii 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
$12.88
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.