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 $1.29 Median $2.69 Typical High $2.69 | Professional | None | $1.29 | $2.69 | $2.69 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.02 Median $3.02 Typical High $3.31 | Professional | None | $3.02 | $3.02 | $3.31 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $0.30 Median $0.30 Typical High $0.33 | Professional | RR · Rental | $0.30 | $0.30 | $0.33 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $2.24 Median $2.24 Typical High $2.45 | Professional | UE · Used equipment | $2.24 | $2.24 | $2.45 |
Cigna Setting Facility Modifier None Typical Low $2.69 Median $2.82 Typical High $3.09 | Facility | None | $2.69 | $2.82 | $3.09 |
Cigna Setting Professional Modifier None Typical Low $2.40 Median $2.40 Typical High $2.82 | Professional | None | $2.40 | $2.40 | $2.82 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1.86 Median $4.17 Typical High $5.37 | Professional | None | $1.86 | $4.17 | $5.37 |
Martin's Point Setting Professional Modifier None Typical Low $1.29 Median $2.69 Typical High $2.69 | Professional | None | $1.29 | $2.69 | $2.69 |
United Setting Professional Modifier None Typical Low $1.86 Median $2.34 Typical High $6.61 | Professional | None | $1.86 | $2.34 | $6.61 |
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 $1.35 Median $1.35 Typical High $1.35 | Professional | 52 · Reduced service | $1.35 | $1.35 | $1.35 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.54 Median $0.54 Typical High $0.54 | Professional | 53 · Discontinued | $0.54 | $0.54 | $0.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.41 Median $0.41 Typical High $0.41 | Professional | 55 · Aftercare only | $0.41 | $0.41 | $0.41 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.27 Median $0.27 Typical High $0.27 | Professional | 56 · Pre-op care only | $0.27 | $0.27 | $0.27 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.35 Median $1.35 Typical High $1.35 | Professional | 52 · Reduced service | $1.35 | $1.35 | $1.35 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.54 Median $0.54 Typical High $0.54 | Professional | 53 · Discontinued | $0.54 | $0.54 | $0.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.41 Median $0.41 Typical High $0.41 | Professional | 55 · Aftercare only | $0.41 | $0.41 | $0.41 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.27 Median $0.27 Typical High $0.27 | Professional | 56 · Pre-op care only | $0.27 | $0.27 | $0.27 |
Where Maine sits
The same service costs 2.2 times more in Kansas 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· 34th of 51
$3.02
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.