How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 Facility Modifier None Typical Low $0.34 Median $0.34 Typical High $0.34 | Facility | None | $0.34 | $0.34 | $0.34 |
Aetna Setting Professional Modifier None Typical Low $0.33 Median $0.35 Typical High $0.35 | Professional | None | $0.33 | $0.35 | $0.35 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.22 Median $0.22 Typical High $0.23 | Professional | None | $0.22 | $0.22 | $0.23 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.12 Median $0.16 Typical High $0.21 | Professional | UE · Used equipment | $0.12 | $0.16 | $0.21 |
Cigna Setting Professional Modifier None Typical Low $0.31 Median $0.31 Typical High $0.31 | Professional | None | $0.31 | $0.31 | $0.31 |
Community Health Options Setting Facility Modifier None Typical Low $2.04 Median $2.04 Typical High $2.04 | Facility | None | $2.04 | $2.04 | $2.04 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $0.28 Median $0.51 Typical High $0.54 | Professional | None | $0.28 | $0.51 | $0.54 |
Martin's Point Setting Facility Modifier None Typical Low $0.34 Median $0.34 Typical High $0.34 | Facility | None | $0.34 | $0.34 | $0.34 |
Martin's Point Setting Professional Modifier None Typical Low $0.33 Median $0.35 Typical High $0.37 | Professional | None | $0.33 | $0.35 | $0.37 |
United Setting Professional Modifier None Typical Low $0.24 Median $0.31 Typical High $0.71 | Professional | None | $0.24 | $0.31 | $0.71 |
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 $0.18 Median $0.18 Typical High $0.18 | Professional | 52 · Reduced service | $0.18 | $0.18 | $0.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.07 Median $0.07 Typical High $0.07 | Professional | 53 · Discontinued | $0.07 | $0.07 | $0.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.04 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $0.04 |
Aetna Setting Professional Modifier RR · Rental Typical Low $0.04 Median $0.04 Typical High $0.08 | Professional | RR · Rental | $0.04 | $0.04 | $0.08 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $0.18 Median $0.18 Typical High $0.18 | Professional | 52 · Reduced service | $0.18 | $0.18 | $0.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.07 Median $0.07 Typical High $0.07 | Professional | 53 · Discontinued | $0.07 | $0.07 | $0.07 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.05 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.04 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $0.04 |
Martin's Point Setting Professional Modifier RR · Rental Typical Low $0.04 Median $0.04 Typical High $0.08 | Professional | RR · Rental | $0.04 | $0.04 | $0.08 |
Where Maine sits
The same service costs 4.6 times more in Hawaii than in Rhode Island. 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· 38th of 51
$0.31
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.