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 $6.76 Median $6.76 Typical High $10.23 | Professional | None | $6.76 | $6.76 | $10.23 |
Anthem BCBS Setting Professional Modifier None Typical Low $8.91 Median $12.02 Typical High $12.02 | Professional | None | $8.91 | $12.02 | $12.02 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.89 Median $1.20 Typical High $1.20 | Professional | RR · Rental | $0.89 | $1.20 | $1.20 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $6.76 Median $8.91 Typical High $8.91 | Professional | UE · Used equipment | $6.76 | $8.91 | $8.91 |
Cigna Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | None | $4.90 | $4.90 | $4.90 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $5.50 Median $10.23 Typical High $12.30 | Professional | None | $5.50 | $10.23 | $12.30 |
Martin's Point Setting Professional Modifier None Typical Low $6.76 Median $6.76 Typical High $10.23 | Professional | None | $6.76 | $6.76 | $10.23 |
United Setting Professional Modifier None Typical Low $4.57 Median $5.75 Typical High $13.49 | Professional | None | $4.57 | $5.75 | $13.49 |
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 $3.39 Median $3.39 Typical High $3.39 | Professional | 52 · Reduced service | $3.39 | $3.39 | $3.39 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.35 Median $1.35 Typical High $1.35 | Professional | 53 · Discontinued | $1.35 | $1.35 | $1.35 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $5.01 Median $5.01 Typical High $5.01 | Professional | 54 · Surgery only | $5.01 | $5.01 | $5.01 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | 55 · Aftercare only | $1.00 | $1.00 | $1.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.68 Median $0.68 Typical High $0.68 | Professional | 56 · Pre-op care only | $0.68 | $0.68 | $0.68 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | 52 · Reduced service | $3.39 | $3.39 | $3.39 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $1.35 Median $1.35 Typical High $1.35 | Professional | 53 · Discontinued | $1.35 | $1.35 | $1.35 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $5.01 Median $5.01 Typical High $5.01 | Professional | 54 · Surgery only | $5.01 | $5.01 | $5.01 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | 55 · Aftercare only | $1.00 | $1.00 | $1.00 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.68 Median $0.68 Typical High $0.68 | Professional | 56 · Pre-op care only | $0.68 | $0.68 | $0.68 |
Where Maine sits
The same service costs 2.9 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· 20th of 51
$8.91
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.