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 $6.61 Median $6.61 Typical High $6.61 | Professional | None | $6.61 | $6.61 | $6.61 |
Anthem BCBS Setting Professional Modifier None Typical Low $4.90 Median $5.75 Typical High $6.31 | Professional | None | $4.90 | $5.75 | $6.31 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.58 Median $0.58 Typical High $0.63 | Professional | RR · Rental | $0.58 | $0.58 | $0.63 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $4.37 Median $4.37 Typical High $4.79 | Professional | UE · Used equipment | $4.37 | $4.37 | $4.79 |
Cigna Setting Facility Modifier None Typical Low $7.59 Median $7.59 Typical High $9.12 | Facility | None | $7.59 | $7.59 | $9.12 |
Cigna Setting Professional Modifier None Typical Low $6.46 Median $6.46 Typical High $7.59 | Professional | None | $6.46 | $6.46 | $7.59 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $4.47 Median $10.00 Typical High $13.18 | Professional | None | $4.47 | $10.00 | $13.18 |
Martin's Point Setting Professional Modifier None Typical Low $6.61 Median $6.61 Typical High $6.61 | Professional | None | $6.61 | $6.61 | $6.61 |
United Setting Professional Modifier None Typical Low $4.47 Median $5.75 Typical High $15.85 | Professional | None | $4.47 | $5.75 | $15.85 |
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 $3.31 Median $3.31 Typical High $3.31 | Professional | 52 · Reduced service | $3.31 | $3.31 | $3.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.32 Median $1.32 Typical High $1.32 | Professional | 53 · Discontinued | $1.32 | $1.32 | $1.32 |
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 $0.66 Median $0.66 Typical High $0.66 | Professional | 56 · Pre-op care only | $0.66 | $0.66 | $0.66 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $3.31 Median $3.31 Typical High $3.31 | Professional | 52 · Reduced service | $3.31 | $3.31 | $3.31 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $1.32 Median $1.32 Typical High $1.32 | Professional | 53 · Discontinued | $1.32 | $1.32 | $1.32 |
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 $0.66 Median $0.66 Typical High $0.66 | Professional | 56 · Pre-op care only | $0.66 | $0.66 | $0.66 |
Where Maine sits
The same service costs 2.1 times more in Idaho than in Connecticut. 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· 48th of 51
$6.17
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.