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 $14.79 Median $14.79 Typical High $24.55 | Professional | None | $14.79 | $14.79 | $24.55 |
Anthem BCBS Setting Professional Modifier None Typical Low $22.39 Median $26.30 Typical High $28.84 | Professional | None | $22.39 | $26.30 | $28.84 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.95 Median $2.63 Typical High $2.63 | Professional | RR · Rental | $1.95 | $2.63 | $2.63 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $14.79 Median $19.50 Typical High $19.50 | Professional | UE · Used equipment | $14.79 | $19.50 | $19.50 |
Cigna Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $10.72 | Professional | None | $10.72 | $10.72 | $10.72 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $12.30 Median $22.39 Typical High $22.91 | Professional | None | $12.30 | $22.39 | $22.91 |
Martin's Point Setting Professional Modifier None Typical Low $14.79 Median $14.79 Typical High $24.55 | Professional | None | $14.79 | $14.79 | $24.55 |
United Setting Professional Modifier None Typical Low $10.00 Median $12.88 Typical High $29.51 | Professional | None | $10.00 | $12.88 | $29.51 |
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 $7.41 Median $7.41 Typical High $7.41 | Professional | 52 · Reduced service | $7.41 | $7.41 | $7.41 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.95 Median $2.95 Typical High $2.95 | Professional | 53 · Discontinued | $2.95 | $2.95 | $2.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.96 Median $10.96 Typical High $10.96 | Professional | 54 · Surgery only | $10.96 | $10.96 | $10.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.19 Median $2.19 Typical High $2.19 | Professional | 55 · Aftercare only | $2.19 | $2.19 | $2.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.48 Median $1.48 Typical High $1.48 | Professional | 56 · Pre-op care only | $1.48 | $1.48 | $1.48 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $7.41 Median $7.41 Typical High $7.41 | Professional | 52 · Reduced service | $7.41 | $7.41 | $7.41 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.95 Median $2.95 Typical High $2.95 | Professional | 53 · Discontinued | $2.95 | $2.95 | $2.95 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $10.96 Median $10.96 Typical High $10.96 | Professional | 54 · Surgery only | $10.96 | $10.96 | $10.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.19 Median $2.19 Typical High $2.19 | Professional | 55 · Aftercare only | $2.19 | $2.19 | $2.19 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.48 Median $1.48 Typical High $1.48 | Professional | 56 · Pre-op care only | $1.48 | $1.48 | $1.48 |
Where Maine sits
The same service costs 3.5 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
$20.42
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.