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 $3.72 Median $3.72 Typical High $3.72 | Professional | None | $3.72 | $3.72 | $3.72 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.24 Median $3.39 Typical High $3.47 | Professional | None | $3.24 | $3.39 | $3.47 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.32 Median $0.32 Typical High $0.35 | Professional | RR · Rental | $0.32 | $0.32 | $0.35 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $2.40 Median $2.40 Typical High $2.63 | Professional | UE · Used equipment | $2.40 | $2.40 | $2.63 |
Cigna Setting Facility Modifier None Typical Low $3.89 Median $3.89 Typical High $4.79 | Facility | None | $3.89 | $3.89 | $4.79 |
Cigna Setting Professional Modifier None Typical Low $3.31 Median $3.31 Typical High $3.89 | Professional | None | $3.31 | $3.31 | $3.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2.51 Median $5.75 Typical High $7.41 | Professional | None | $2.51 | $5.75 | $7.41 |
Martin's Point Setting Professional Modifier None Typical Low $3.72 Median $3.72 Typical High $3.72 | Professional | None | $3.72 | $3.72 | $3.72 |
United Setting Professional Modifier None Typical Low $2.51 Median $3.24 Typical High $9.12 | Professional | None | $2.51 | $3.24 | $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 $1.86 Median $1.86 Typical High $1.86 | Professional | 52 · Reduced service | $1.86 | $1.86 | $1.86 |
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 $1.86 Median $1.86 Typical High $1.86 | Professional | 52 · Reduced service | $1.86 | $1.86 | $1.86 |
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 Montana than in New Jersey. 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· 42nd of 51
$3.39
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.