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 $4.57 Median $4.57 Typical High $4.57 | Professional | None | $4.57 | $4.57 | $4.57 |
Anthem BCBS Setting Professional Modifier None Typical Low $125.89 Median $125.89 Typical High $134.90 | Professional | None | $125.89 | $125.89 | $134.90 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $12.59 Median $12.59 Typical High $13.80 | Professional | RR · Rental | $12.59 | $12.59 | $13.80 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $93.33 Median $93.33 Typical High $102.33 | Professional | UE · Used equipment | $93.33 | $93.33 | $102.33 |
Cigna Setting Facility Modifier None Typical Low $9.33 Median $9.33 Typical High $10.00 | Facility | None | $9.33 | $9.33 | $10.00 |
Cigna Setting Professional Modifier None Typical Low $6.76 Median $6.76 Typical High $9.33 | Professional | None | $6.76 | $6.76 | $9.33 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $5.01 Median $13.80 Typical High $32.36 | Professional | None | $5.01 | $13.80 | $32.36 |
Martin's Point Setting Professional Modifier None Typical Low $4.57 Median $4.57 Typical High $4.57 | Professional | None | $4.57 | $4.57 | $4.57 |
United Setting Professional Modifier None Typical Low $4.07 Median $6.03 Typical High $16.22 | Professional | None | $4.07 | $6.03 | $16.22 |
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 $2.29 Median $2.29 Typical High $2.29 | Professional | 52 · Reduced service | $2.29 | $2.29 | $2.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.91 Median $0.91 Typical High $0.91 | Professional | 53 · Discontinued | $0.91 | $0.91 | $0.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.68 Median $0.68 Typical High $0.68 | Professional | 55 · Aftercare only | $0.68 | $0.68 | $0.68 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.45 Median $0.45 Typical High $0.45 | Professional | 56 · Pre-op care only | $0.45 | $0.45 | $0.45 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2.29 Median $2.29 Typical High $2.29 | Professional | 52 · Reduced service | $2.29 | $2.29 | $2.29 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.91 Median $0.91 Typical High $0.91 | Professional | 53 · Discontinued | $0.91 | $0.91 | $0.91 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.68 Median $0.68 Typical High $0.68 | Professional | 55 · Aftercare only | $0.68 | $0.68 | $0.68 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.45 Median $0.45 Typical High $0.45 | Professional | 56 · Pre-op care only | $0.45 | $0.45 | $0.45 |
Where Maine sits
The same service costs 39.8 times more in New York than in Hawaii. 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· 6th of 51
$13.49
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.