How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $95.50 Median $95.50 Typical High $95.50 | Facility | None | $95.50 | $95.50 | $95.50 |
Aetna Setting Professional Modifier None Typical Low $87.10 Median $95.50 Typical High $95.50 | Professional | None | $87.10 | $95.50 | $95.50 |
AllWays Health Partners Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $128.82 | Facility | None | $89.13 | $89.13 | $128.82 |
AllWays Health Partners Setting Professional Modifier None Typical Low $91.20 Median $316.23 Typical High $524.81 | Professional | None | $91.20 | $316.23 | $524.81 |
Cigna Setting Facility Modifier None Typical Low $524.81 Median $588.84 Typical High $870.96 | Facility | None | $524.81 | $588.84 | $870.96 |
Fallon Health Setting Facility Modifier None Typical Low $83.18 Median $162.18 Typical High $5,888.44 | Facility | None | $83.18 | $162.18 | $5,888.44 |
Fallon Health Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $162.18 | Professional | None | $138.04 | $138.04 | $162.18 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $100.00 Median $169.82 Typical High $302.00 | Professional | None | $100.00 | $169.82 | $302.00 |
Mass General Brigham Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $128.82 | Facility | None | $89.13 | $89.13 | $128.82 |
Mass General Brigham Setting Professional Modifier None Typical Low $91.20 Median $316.23 Typical High $524.81 | Professional | None | $91.20 | $316.23 | $524.81 |
United Setting Facility Modifier None Typical Low $478.63 Median $912.01 Typical High $1,348.96 | Facility | None | $478.63 | $912.01 | $1,348.96 |
United Setting Professional Modifier None Typical Low $87.10 Median $120.23 Typical High $213.80 | Professional | None | $87.10 | $120.23 | $213.80 |
Well Sense Setting Facility Modifier None Typical Low $2,951.21 Median $3,630.78 Typical High $4,897.79 | Facility | None | $2,951.21 | $3,630.78 | $4,897.79 |
Well Sense Setting Professional Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $3,019.95 | Professional | None | $2,511.89 | $2,511.89 | $3,019.95 |
4 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 $42.66 Median $47.86 Typical High $47.86 | Professional | 52 · Reduced service | $42.66 | $47.86 | $47.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $19.50 Typical High $19.50 | Professional | 53 · Discontinued | $17.38 | $19.50 | $19.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $14.45 Typical High $14.45 | Professional | 55 · Aftercare only | $12.88 | $14.45 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $9.55 Typical High $9.55 | Professional | 56 · Pre-op care only | $8.71 | $9.55 | $9.55 |
Where Massachusetts sits
The same service costs 5.0 times more in Alaska than in Pennsylvania. 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.
Massachusetts· 8th of 51
$141
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.