How much rates vary
Facilitymedian $43 · 10th to 90th $21 to $100Professionalmedian $68 · 10th to 90th $34 to $174
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 $24.55 Median $43.65 Typical High $67.61 | Facility | None | $24.55 | $43.65 | $67.61 |
Aetna Setting Professional Modifier None Typical Low $24.55 Median $51.29 Typical High $75.86 | Professional | None | $24.55 | $51.29 | $75.86 |
AllWays Health Partners Setting Facility Modifier None Typical Low $31.62 Median $43.65 Typical High $102.33 | Facility | None | $31.62 | $43.65 | $102.33 |
AllWays Health Partners Setting Professional Modifier None Typical Low $33.11 Median $85.11 Typical High $354.81 | Professional | None | $33.11 | $85.11 | $354.81 |
AllWays Health Partners Setting Professional Modifier 25 · Same-day visit Typical Low $19.50 Median $41.69 Typical High $83.18 | Professional | 25 · Same-day visit | $19.50 | $41.69 | $83.18 |
BCBS Massachusetts Setting Facility Modifier None Typical Low $33.88 Median $63.10 Typical High $87.10 | Facility | None | $33.88 | $63.10 | $87.10 |
BCBS Massachusetts Setting Professional Modifier None Typical Low $33.88 Median $69.18 Typical High $114.82 | Professional | None | $33.88 | $69.18 | $114.82 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $199.53 Typical High $223.87 | Facility | None | $151.36 | $199.53 | $223.87 |
Cigna Setting Professional Modifier None Typical Low $38.90 Median $66.07 Typical High $123.03 | Professional | None | $38.90 | $66.07 | $123.03 |
Fallon Health Setting Facility Modifier None Typical Low $19.05 Median $29.51 Typical High $50.12 | Facility | None | $19.05 | $29.51 | $50.12 |
Fallon Health Setting Professional Modifier None Typical Low $38.02 Median $60.26 Typical High $102.33 | Professional | None | $38.02 | $60.26 | $102.33 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $34.67 Median $72.44 Typical High $154.88 | Professional | None | $34.67 | $72.44 | $154.88 |
Health New England Setting Facility Modifier None Typical Low $60.26 Median $67.61 Typical High $97.72 | Facility | None | $60.26 | $67.61 | $97.72 |
Health New England Setting Professional Modifier None Typical Low $64.57 Median $102.33 Typical High $416.87 | Professional | None | $64.57 | $102.33 | $416.87 |
Mass General Brigham Setting Facility Modifier None Typical Low $31.62 Median $43.65 Typical High $102.33 | Facility | None | $31.62 | $43.65 | $102.33 |
Mass General Brigham Setting Professional Modifier None Typical Low $33.11 Median $85.11 Typical High $354.81 | Professional | None | $33.11 | $85.11 | $354.81 |
Mass General Brigham Setting Professional Modifier 25 · Same-day visit Typical Low $19.50 Median $41.69 Typical High $83.18 | Professional | 25 · Same-day visit | $19.50 | $41.69 | $83.18 |
Tufts Setting Facility Modifier None Typical Low $19.50 Median $61.66 Typical High $407.38 | Facility | None | $19.50 | $61.66 | $407.38 |
Tufts Setting Professional Modifier None Typical Low $26.30 Median $48.98 Typical High $107.15 | Professional | None | $26.30 | $48.98 | $107.15 |
United Setting Professional Modifier None Typical Low $27.54 Median $60.26 Typical High $134.90 | Professional | None | $27.54 | $60.26 | $134.90 |
Well Sense Setting Facility Modifier None Typical Low $36.31 Median $51.29 Typical High $75.86 | Facility | None | $36.31 | $51.29 | $75.86 |
Well Sense Setting Professional Modifier None Typical Low $18.20 Median $18.20 Typical High $21.88 | Professional | None | $18.20 | $18.20 | $21.88 |
18 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 $12.30 Median $21.88 Typical High $22.39 | Professional | 52 · Reduced service | $12.30 | $21.88 | $22.39 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.72 Median $6.46 Typical High $6.76 | Professional | 55 · Aftercare only | $3.72 | $6.46 | $6.76 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.45 Median $4.37 Typical High $4.47 | Professional | 56 · Pre-op care only | $2.45 | $4.37 | $4.47 |
BCBS Massachusetts Setting Professional Modifier 55 · Aftercare only Typical Low $6.61 Median $22.91 Typical High $31.62 | Professional | 55 · Aftercare only | $6.61 | $22.91 | $31.62 |
BCBS Massachusetts Setting Professional Modifier 78 · Unplanned return to OR Typical Low $46.77 Median $66.07 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $46.77 | $66.07 | $107.15 |
BCBS Massachusetts Setting Professional Modifier 80 · Assistant surgeon Typical Low $9.33 Median $11.75 Typical High $17.78 | Professional | 80 · Assistant surgeon | $9.33 | $11.75 | $17.78 |
Fallon Health Setting Facility Modifier SA · Nurse practitioner Typical Low $44.67 Median $57.54 Typical High $67.61 | Facility | SA · Nurse practitioner | $44.67 | $57.54 | $67.61 |
Fallon Health Setting Facility Modifier TD · Registered nurse Typical Low $57.54 Median $57.54 Typical High $63.10 | Facility | TD · Registered nurse | $57.54 | $57.54 | $63.10 |
Fallon Health Setting Facility Modifier U6 · State-defined Typical Low $52.48 Median $67.61 Typical High $81.28 | Facility | U6 · State-defined | $52.48 | $67.61 | $81.28 |
Fallon Health Setting Facility Modifier UG · Afternoon Typical Low $52.48 Median $52.48 Typical High $57.54 | Facility | UG · Afternoon | $52.48 | $52.48 | $57.54 |
Fallon Health Setting Professional Modifier SA · Nurse practitioner Typical Low $57.54 Median $57.54 Typical High $63.10 | Professional | SA · Nurse practitioner | $57.54 | $57.54 | $63.10 |
Fallon Health Setting Professional Modifier TD · Registered nurse Typical Low $57.54 Median $63.10 Typical High $63.10 | Professional | TD · Registered nurse | $57.54 | $63.10 | $63.10 |
Fallon Health Setting Professional Modifier U6 · State-defined Typical Low $66.07 Median $67.61 Typical High $74.13 | Professional | U6 · State-defined | $66.07 | $67.61 | $74.13 |
Fallon Health Setting Professional Modifier UG · Afternoon Typical Low $52.48 Median $52.48 Typical High $52.48 | Professional | UG · Afternoon | $52.48 | $52.48 | $52.48 |
Well Sense Setting Facility Modifier SA · Nurse practitioner Typical Low $44.67 Median $58.88 Typical High $104.71 | Facility | SA · Nurse practitioner | $44.67 | $58.88 | $104.71 |
Well Sense Setting Facility Modifier U4 · State-defined Typical Low $144.54 Median $204.17 Typical High $354.81 | Facility | U4 · State-defined | $144.54 | $204.17 | $354.81 |
Well Sense Setting Professional Modifier GF · Non-physician, rural hospital Typical Low $22.39 Median $22.39 Typical High $26.92 | Professional | GF · Non-physician, rural hospital | $22.39 | $22.39 | $26.92 |
Well Sense Setting Professional Modifier U4 · State-defined Typical Low $169.82 Median $169.82 Typical High $204.17 | Professional | U4 · State-defined | $169.82 | $169.82 | $204.17 |
Where Massachusetts sits
The same service costs 2.4 times more in Alaska 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.
Massachusetts· 3rd of 51
$67.61
AK $77.62NJ $32.36
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.