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 $2.75 Median $2.75 Typical High $2.75 | Professional | None | $2.75 | $2.75 | $2.75 |
Anthem BCBS Setting Professional Modifier None Typical Low $1.35 Median $1.82 Typical High $1.86 | Professional | None | $1.35 | $1.82 | $1.86 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.18 Median $0.18 Typical High $0.18 | Professional | RR · Rental | $0.18 | $0.18 | $0.18 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $1.02 Median $1.38 Typical High $1.38 | Professional | UE · Used equipment | $1.02 | $1.38 | $1.38 |
Cigna Setting Professional Modifier None Typical Low $2.00 Median $2.00 Typical High $2.00 | Professional | None | $2.00 | $2.00 | $2.00 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2.24 Median $4.17 Typical High $4.17 | Professional | None | $2.24 | $4.17 | $4.17 |
Martin's Point Setting Professional Modifier None Typical Low $2.75 Median $2.75 Typical High $2.75 | Professional | None | $2.75 | $2.75 | $2.75 |
United Setting Professional Modifier None Typical Low $1.86 Median $2.40 Typical High $5.50 | Professional | None | $1.86 | $2.40 | $5.50 |
8 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 $1.38 Median $1.38 Typical High $1.38 | Professional | 52 · Reduced service | $1.38 | $1.38 | $1.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.55 Median $0.55 Typical High $0.55 | Professional | 53 · Discontinued | $0.55 | $0.55 | $0.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.41 Median $0.41 Typical High $0.41 | Professional | 55 · Aftercare only | $0.41 | $0.41 | $0.41 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.27 Median $0.27 Typical High $0.27 | Professional | 56 · Pre-op care only | $0.27 | $0.27 | $0.27 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.38 Median $1.38 Typical High $1.38 | Professional | 52 · Reduced service | $1.38 | $1.38 | $1.38 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.55 Median $0.55 Typical High $0.55 | Professional | 53 · Discontinued | $0.55 | $0.55 | $0.55 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.41 Median $0.41 Typical High $0.41 | Professional | 55 · Aftercare only | $0.41 | $0.41 | $0.41 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.27 Median $0.27 Typical High $0.27 | Professional | 56 · Pre-op care only | $0.27 | $0.27 | $0.27 |
Where Maine sits
The same service costs 2.6 times more in Hawaii than in Maine. 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· 51st of 51
$2.00
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.