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 $7.76 Median $7.76 Typical High $7.76 | Professional | None | $7.76 | $7.76 | $7.76 |
Anthem BCBS Setting Professional Modifier None Typical Low $6.61 Median $6.92 Typical High $7.08 | Professional | None | $6.61 | $6.92 | $7.08 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.66 Median $0.66 Typical High $0.72 | Professional | RR · Rental | $0.66 | $0.66 | $0.72 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $4.90 Median $4.90 Typical High $5.37 | Professional | UE · Used equipment | $4.90 | $4.90 | $5.37 |
Cigna Setting Facility Modifier None Typical Low $8.13 Median $8.13 Typical High $8.71 | Facility | None | $8.13 | $8.13 | $8.71 |
Cigna Setting Professional Modifier None Typical Low $6.92 Median $6.92 Typical High $8.13 | Professional | None | $6.92 | $6.92 | $8.13 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $5.25 Median $11.75 Typical High $15.49 | Professional | None | $5.25 | $11.75 | $15.49 |
Martin's Point Setting Professional Modifier None Typical Low $7.76 Median $7.76 Typical High $7.76 | Professional | None | $7.76 | $7.76 | $7.76 |
United Setting Professional Modifier None Typical Low $5.25 Median $6.76 Typical High $18.62 | Professional | None | $5.25 | $6.76 | $18.62 |
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 $3.89 Median $3.89 Typical High $3.89 | Professional | 52 · Reduced service | $3.89 | $3.89 | $3.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.55 Median $1.55 Typical High $1.55 | Professional | 53 · Discontinued | $1.55 | $1.55 | $1.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.15 Median $1.15 Typical High $1.15 | Professional | 55 · Aftercare only | $1.15 | $1.15 | $1.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.78 Median $0.78 Typical High $0.78 | Professional | 56 · Pre-op care only | $0.78 | $0.78 | $0.78 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $3.89 Median $3.89 Typical High $3.89 | Professional | 52 · Reduced service | $3.89 | $3.89 | $3.89 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $1.55 Median $1.55 Typical High $1.55 | Professional | 53 · Discontinued | $1.55 | $1.55 | $1.55 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.15 Median $1.15 Typical High $1.15 | Professional | 55 · Aftercare only | $1.15 | $1.15 | $1.15 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.78 Median $0.78 Typical High $0.78 | Professional | 56 · Pre-op care only | $0.78 | $0.78 | $0.78 |
Where Maine sits
The same service costs 2.2 times more in Hawaii than in Maine. 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· 51st of 51
$6.92
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.