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 $24.55 Median $24.55 Typical High $37.15 | Professional | None | $24.55 | $24.55 | $37.15 |
Anthem BCBS Setting Professional Modifier None Typical Low $32.36 Median $43.65 Typical High $43.65 | Professional | None | $32.36 | $43.65 | $43.65 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $3.24 Median $4.37 Typical High $4.37 | Professional | RR · Rental | $3.24 | $4.37 | $4.37 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $24.55 Median $32.36 Typical High $32.36 | Professional | UE · Used equipment | $24.55 | $32.36 | $32.36 |
Cigna Setting Professional Modifier None Typical Low $17.78 Median $17.78 Typical High $17.78 | Professional | None | $17.78 | $17.78 | $17.78 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $20.42 Median $37.15 Typical High $38.02 | Professional | None | $20.42 | $37.15 | $38.02 |
Martin's Point Setting Professional Modifier None Typical Low $24.55 Median $24.55 Typical High $37.15 | Professional | None | $24.55 | $24.55 | $37.15 |
United Setting Professional Modifier None Typical Low $16.60 Median $21.38 Typical High $48.98 | Professional | None | $16.60 | $21.38 | $48.98 |
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 $12.30 Median $12.30 Typical High $12.30 | Professional | 52 · Reduced service | $12.30 | $12.30 | $12.30 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | 53 · Discontinued | $4.90 | $4.90 | $4.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $18.20 Median $18.20 Typical High $18.20 | Professional | 54 · Surgery only | $18.20 | $18.20 | $18.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.63 Median $3.63 Typical High $3.63 | Professional | 55 · Aftercare only | $3.63 | $3.63 | $3.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.45 Median $2.45 Typical High $2.45 | Professional | 56 · Pre-op care only | $2.45 | $2.45 | $2.45 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $12.30 Median $12.30 Typical High $12.30 | Professional | 52 · Reduced service | $12.30 | $12.30 | $12.30 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | 53 · Discontinued | $4.90 | $4.90 | $4.90 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $18.20 Median $18.20 Typical High $18.20 | Professional | 54 · Surgery only | $18.20 | $18.20 | $18.20 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.63 Median $3.63 Typical High $3.63 | Professional | 55 · Aftercare only | $3.63 | $3.63 | $3.63 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.45 Median $2.45 Typical High $2.45 | Professional | 56 · Pre-op care only | $2.45 | $2.45 | $2.45 |
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· 22nd of 51
$32.36
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.