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 Facility Modifier None Typical Low $9.77 Median $9.77 Typical High $9.77 | Facility | None | $9.77 | $9.77 | $9.77 |
Aetna Setting Professional Modifier None Typical Low $8.51 Median $9.77 Typical High $13.80 | Professional | None | $8.51 | $9.77 | $13.80 |
Anthem BCBS Setting Professional Modifier None Typical Low $14.13 Median $14.45 Typical High $15.14 | Professional | None | $14.13 | $14.45 | $15.14 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $1.41 Median $1.41 Typical High $1.55 | Professional | RR · Rental | $1.41 | $1.41 | $1.55 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $10.72 Median $10.72 Typical High $11.48 | Professional | UE · Used equipment | $10.72 | $10.72 | $11.48 |
Cigna Setting Facility Modifier None Typical Low $20.89 Median $20.89 Typical High $23.44 | Facility | None | $20.89 | $20.89 | $23.44 |
Cigna Setting Professional Modifier None Typical Low $15.49 Median $15.49 Typical High $20.89 | Professional | None | $15.49 | $15.49 | $20.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $6.61 Median $17.78 Typical High $40.74 | Professional | None | $6.61 | $17.78 | $40.74 |
Martin's Point Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $13.80 | Professional | None | $9.77 | $9.77 | $13.80 |
United Setting Professional Modifier None Typical Low $5.37 Median $7.94 Typical High $21.38 | Professional | None | $5.37 | $7.94 | $21.38 |
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 $4.37 Median $4.90 Typical High $4.90 | Professional | 52 · Reduced service | $4.37 | $4.90 | $4.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.78 Median $1.95 Typical High $1.95 | Professional | 53 · Discontinued | $1.78 | $1.95 | $1.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.32 Median $1.48 Typical High $1.48 | Professional | 55 · Aftercare only | $1.32 | $1.48 | $1.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.87 Median $0.98 Typical High $0.98 | Professional | 56 · Pre-op care only | $0.87 | $0.98 | $0.98 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $4.37 Median $4.90 Typical High $4.90 | Professional | 52 · Reduced service | $4.37 | $4.90 | $4.90 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $1.78 Median $1.95 Typical High $1.95 | Professional | 53 · Discontinued | $1.78 | $1.95 | $1.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.32 Median $1.48 Typical High $1.48 | Professional | 55 · Aftercare only | $1.32 | $1.48 | $1.48 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.87 Median $0.98 Typical High $0.98 | Professional | 56 · Pre-op care only | $0.87 | $0.98 | $0.98 |
Where Maine sits
The same service costs 6.2 times more in Wyoming than in North Carolina. 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· 27th of 51
$14.13
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.