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 $14.45 Median $14.45 Typical High $14.45 | Professional | None | $14.45 | $14.45 | $14.45 |
Anthem BCBS Setting Professional Modifier None Typical Low $21.88 Median $25.70 Typical High $28.18 | Professional | None | $21.88 | $25.70 | $28.18 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.91 Median $2.51 Typical High $2.51 | Professional | RR · Rental | $1.91 | $2.51 | $2.51 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $14.45 Median $19.05 Typical High $19.05 | Professional | UE · Used equipment | $14.45 | $19.05 | $19.05 |
Cigna Setting Professional Modifier None Typical Low $10.47 Median $10.47 Typical High $10.47 | Professional | None | $10.47 | $10.47 | $10.47 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $11.75 Median $21.88 Typical High $22.39 | Professional | None | $11.75 | $21.88 | $22.39 |
Martin's Point Setting Professional Modifier None Typical Low $14.45 Median $14.45 Typical High $14.45 | Professional | None | $14.45 | $14.45 | $14.45 |
United Setting Professional Modifier None Typical Low $9.77 Median $12.59 Typical High $28.84 | Professional | None | $9.77 | $12.59 | $28.84 |
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 $7.24 Median $7.24 Typical High $7.24 | Professional | 52 · Reduced service | $7.24 | $7.24 | $7.24 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.88 Median $2.88 Typical High $2.88 | Professional | 53 · Discontinued | $2.88 | $2.88 | $2.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.72 Median $10.72 Typical High $10.72 | Professional | 54 · Surgery only | $10.72 | $10.72 | $10.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.14 Median $2.14 Typical High $2.14 | Professional | 55 · Aftercare only | $2.14 | $2.14 | $2.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.45 Median $1.45 Typical High $1.45 | Professional | 56 · Pre-op care only | $1.45 | $1.45 | $1.45 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $7.24 Median $7.24 Typical High $7.24 | Professional | 52 · Reduced service | $7.24 | $7.24 | $7.24 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.88 Median $2.88 Typical High $2.88 | Professional | 53 · Discontinued | $2.88 | $2.88 | $2.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $10.72 Median $10.72 Typical High $10.72 | Professional | 54 · Surgery only | $10.72 | $10.72 | $10.72 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.14 Median $2.14 Typical High $2.14 | Professional | 55 · Aftercare only | $2.14 | $2.14 | $2.14 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.45 Median $1.45 Typical High $1.45 | Professional | 56 · Pre-op care only | $1.45 | $1.45 | $1.45 |
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· 15th of 51
$20.89
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.