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 $2.29 Median $3.02 Typical High $3.02 | Professional | None | $2.29 | $3.02 | $3.02 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.63 Median $2.63 Typical High $2.88 | Professional | None | $2.63 | $2.63 | $2.88 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.26 Median $0.26 Typical High $0.28 | Professional | RR · Rental | $0.26 | $0.26 | $0.28 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $1.95 Median $1.95 Typical High $2.14 | Professional | UE · Used equipment | $1.95 | $1.95 | $2.14 |
Cigna Setting Facility Modifier None Typical Low $3.55 Median $3.55 Typical High $4.17 | Facility | None | $3.55 | $3.55 | $4.17 |
Cigna Setting Professional Modifier None Typical Low $2.95 Median $2.95 Typical High $3.55 | Professional | None | $2.95 | $2.95 | $3.55 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2.04 Median $4.57 Typical High $6.03 | Professional | None | $2.04 | $4.57 | $6.03 |
Martin's Point Setting Professional Modifier None Typical Low $2.29 Median $3.02 Typical High $3.02 | Professional | None | $2.29 | $3.02 | $3.02 |
United Setting Professional Modifier None Typical Low $2.04 Median $2.63 Typical High $7.24 | Professional | None | $2.04 | $2.63 | $7.24 |
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 $1.51 Median $1.51 Typical High $1.51 | Professional | 52 · Reduced service | $1.51 | $1.51 | $1.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.60 Median $0.60 Typical High $0.60 | Professional | 53 · Discontinued | $0.60 | $0.60 | $0.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.45 Median $0.45 Typical High $0.45 | Professional | 55 · Aftercare only | $0.45 | $0.45 | $0.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.30 Median $0.30 Typical High $0.30 | Professional | 56 · Pre-op care only | $0.30 | $0.30 | $0.30 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.51 Median $1.51 Typical High $1.51 | Professional | 52 · Reduced service | $1.51 | $1.51 | $1.51 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.60 Median $0.60 Typical High $0.60 | Professional | 53 · Discontinued | $0.60 | $0.60 | $0.60 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.45 Median $0.45 Typical High $0.45 | Professional | 55 · Aftercare only | $0.45 | $0.45 | $0.45 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.30 Median $0.30 Typical High $0.30 | Professional | 56 · Pre-op care only | $0.30 | $0.30 | $0.30 |
Where Maine sits
The same service costs 2.6 times more in Kansas than in New Hampshire. 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· 46th of 51
$2.88
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.