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 Professional Modifier None Typical Low $3.80 Median $3.80 Typical High $3.80 | Professional | None | $3.80 | $3.80 | $3.80 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.31 Median $3.55 Typical High $3.63 | Professional | None | $3.31 | $3.55 | $3.63 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.33 Median $0.33 Typical High $0.36 | Professional | RR · Rental | $0.33 | $0.33 | $0.36 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $2.51 Median $2.51 Typical High $2.75 | Professional | UE · Used equipment | $2.51 | $2.51 | $2.75 |
Cigna Setting Facility Modifier None Typical Low $3.98 Median $3.98 Typical High $5.25 | Facility | None | $3.98 | $3.98 | $5.25 |
Cigna Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.98 | Professional | None | $3.39 | $3.39 | $3.98 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2.57 Median $5.75 Typical High $7.59 | Professional | None | $2.57 | $5.75 | $7.59 |
Martin's Point Setting Professional Modifier None Typical Low $3.80 Median $3.80 Typical High $3.80 | Professional | None | $3.80 | $3.80 | $3.80 |
United Setting Professional Modifier None Typical Low $2.57 Median $3.31 Typical High $9.12 | Professional | None | $2.57 | $3.31 | $9.12 |
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 $1.91 Median $1.91 Typical High $1.91 | Professional | 52 · Reduced service | $1.91 | $1.91 | $1.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.76 Median $0.76 Typical High $0.76 | Professional | 53 · Discontinued | $0.76 | $0.76 | $0.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.56 Median $0.56 Typical High $0.56 | Professional | 55 · Aftercare only | $0.56 | $0.56 | $0.56 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.38 Median $0.38 Typical High $0.38 | Professional | 56 · Pre-op care only | $0.38 | $0.38 | $0.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.91 Median $1.91 Typical High $1.91 | Professional | 52 · Reduced service | $1.91 | $1.91 | $1.91 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.76 Median $0.76 Typical High $0.76 | Professional | 53 · Discontinued | $0.76 | $0.76 | $0.76 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.56 Median $0.56 Typical High $0.56 | Professional | 55 · Aftercare only | $0.56 | $0.56 | $0.56 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.38 Median $0.38 Typical High $0.38 | Professional | 56 · Pre-op care only | $0.38 | $0.38 | $0.38 |
Where Maine sits
The same service costs 2.1 times more in Kansas than in Alabama. 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· 41st of 51
$3.55
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.