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 $2.14 Median $2.88 Typical High $2.88 | Professional | None | $2.14 | $2.88 | $2.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.51 Median $2.63 Typical High $2.75 | Professional | None | $2.51 | $2.63 | $2.75 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.25 Median $0.25 Typical High $0.27 | Professional | RR · Rental | $0.25 | $0.25 | $0.27 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $1.86 Median $1.86 Typical High $2.04 | Professional | UE · Used equipment | $1.86 | $1.86 | $2.04 |
Cigna Setting Facility Modifier None Typical Low $3.02 Median $3.02 Typical High $3.98 | Facility | None | $3.02 | $3.02 | $3.98 |
Cigna Setting Professional Modifier None Typical Low $2.57 Median $2.57 Typical High $3.02 | Professional | None | $2.57 | $2.57 | $3.02 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1.95 Median $4.37 Typical High $5.75 | Professional | None | $1.95 | $4.37 | $5.75 |
Martin's Point Setting Professional Modifier None Typical Low $2.14 Median $2.88 Typical High $2.88 | Professional | None | $2.14 | $2.88 | $2.88 |
United Setting Professional Modifier None Typical Low $1.95 Median $2.51 Typical High $6.92 | Professional | None | $1.95 | $2.51 | $6.92 |
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 $1.45 Median $1.45 Typical High $1.45 | Professional | 52 · Reduced service | $1.45 | $1.45 | $1.45 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.58 Median $0.58 Typical High $0.58 | Professional | 53 · Discontinued | $0.58 | $0.58 | $0.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.43 Median $0.43 Typical High $0.43 | Professional | 55 · Aftercare only | $0.43 | $0.43 | $0.43 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | 56 · Pre-op care only | $0.28 | $0.28 | $0.28 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.45 Median $1.45 Typical High $1.45 | Professional | 52 · Reduced service | $1.45 | $1.45 | $1.45 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.58 Median $0.58 Typical High $0.58 | Professional | 53 · Discontinued | $0.58 | $0.58 | $0.58 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.43 Median $0.43 Typical High $0.43 | Professional | 55 · Aftercare only | $0.43 | $0.43 | $0.43 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | 56 · Pre-op care only | $0.28 | $0.28 | $0.28 |
Where Maine sits
The same service costs 2.3 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· 40th of 51
$2.63
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.