How much rates vary
Facilitymedian $23 · 10th to 90th $11 to $68Professionalmedian $16 · 10th to 90th $4 to $135
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 $4.37 Median $4.37 Typical High $4.37 | Facility | None | $4.37 | $4.37 | $4.37 |
Aetna Setting Professional Modifier None Typical Low $4.37 Median $4.37 Typical High $4.37 | Professional | None | $4.37 | $4.37 | $4.37 |
AllWays Health Partners Setting Facility Modifier None Typical Low $21.88 Median $23.44 Typical High $70.79 | Facility | None | $21.88 | $23.44 | $70.79 |
AllWays Health Partners Setting Professional Modifier None Typical Low $8.91 Median $20.89 Typical High $134.90 | Professional | None | $8.91 | $20.89 | $134.90 |
BCBS Massachusetts Setting Facility Modifier None Typical Low $3.63 Median $3.63 Typical High $11.22 | Facility | None | $3.63 | $3.63 | $11.22 |
BCBS Massachusetts Setting Professional Modifier None Typical Low $15.49 Median $15.49 Typical High $17.78 | Professional | None | $15.49 | $15.49 | $17.78 |
Cigna Setting Professional Modifier None Typical Low $13.49 Median $13.49 Typical High $18.62 | Professional | None | $13.49 | $13.49 | $18.62 |
Fallon Health Setting Professional Modifier None Typical Low $16.22 Median $16.22 Typical High $16.22 | Professional | None | $16.22 | $16.22 | $16.22 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $8.91 Median $19.95 Typical High $22.39 | Professional | None | $8.91 | $19.95 | $22.39 |
Mass General Brigham Setting Facility Modifier None Typical Low $21.88 Median $23.44 Typical High $70.79 | Facility | None | $21.88 | $23.44 | $70.79 |
Mass General Brigham Setting Professional Modifier None Typical Low $8.91 Median $20.89 Typical High $134.90 | Professional | None | $8.91 | $20.89 | $134.90 |
United Setting Professional Modifier None Typical Low $7.94 Median $12.02 Typical High $22.39 | Professional | None | $7.94 | $12.02 | $22.39 |
Well Sense Setting Facility Modifier None Typical Low $19.05 Median $26.30 Typical High $38.90 | Facility | None | $19.05 | $26.30 | $38.90 |
Well Sense Setting Professional Modifier None Typical Low $15.85 Median $15.85 Typical High $19.05 | Professional | None | $15.85 | $15.85 | $19.05 |
5 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 $2.19 Median $2.19 Typical High $2.19 | Professional | 52 · Reduced service | $2.19 | $2.19 | $2.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.87 Median $0.87 Typical High $0.87 | Professional | 53 · Discontinued | $0.87 | $0.87 | $0.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.66 Median $0.66 Typical High $0.66 | Professional | 55 · Aftercare only | $0.66 | $0.66 | $0.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.44 Median $0.44 Typical High $0.44 | Professional | 56 · Pre-op care only | $0.44 | $0.44 | $0.44 |
Fallon Health Setting Facility Modifier AU · Urologic/ostomy supply + AV · With prosthetic/orthotic + AW · With surgical dressing + KF · Class III device + KL · Delivered by mail + KM · Facial prosthesis, new mold + KN · Facial prosthesis, prior mold + MS · Maintenance fee + NUBA · New equipment + With IV/tube nutrition + NUKC · New equipment + Wheelchair interface replaced + NUKF · New equipment + Class III device + NUKL · New equipment + Delivered by mail + NUKU · New equipment + Bidding program group 3 + NUQB · New equipment + Oxygen over 4 L/min + portable + NUQF · New equipment + Oxygen over 4 L/min at rest + portable + RR · Rental + RRBA · Rental + With IV/tube nutrition + RRKC · Rental + Wheelchair interface replaced + RRKF · Rental + Class III device + RRKU · Rental + Bidding program group 3 + RRQB · Rental + Oxygen over 4 L/min + portable + RRQF · Rental + Oxygen over 4 L/min at rest + portable + UE · Used equipment + UEBA · Used equipment + With IV/tube nutrition + UEKC · Used equipment + Wheelchair interface replaced + UEKF · Used equipment + Class III device + UEKU · Used equipment + Bidding program group 3 Typical Low $23.44 Median $23.44 Typical High $23.44 | Facility | AU · Urologic/ostomy supply + AV · With prosthetic/orthotic + AW · With surgical dressing + KF · Class III device + KL · Delivered by mail + KM · Facial prosthesis, new mold + KN · Facial prosthesis, prior mold + MS · Maintenance fee + NUBA · New equipment + With IV/tube nutrition + NUKC · New equipment + Wheelchair interface replaced + NUKF · New equipment + Class III device + NUKL · New equipment + Delivered by mail + NUKU · New equipment + Bidding program group 3 + NUQB · New equipment + Oxygen over 4 L/min + portable + NUQF · New equipment + Oxygen over 4 L/min at rest + portable + RR · Rental + RRBA · Rental + With IV/tube nutrition + RRKC · Rental + Wheelchair interface replaced + RRKF · Rental + Class III device + RRKU · Rental + Bidding program group 3 + RRQB · Rental + Oxygen over 4 L/min + portable + RRQF · Rental + Oxygen over 4 L/min at rest + portable + UE · Used equipment + UEBA · Used equipment + With IV/tube nutrition + UEKC · Used equipment + Wheelchair interface replaced + UEKF · Used equipment + Class III device + UEKU · Used equipment + Bidding program group 3 | $23.44 | $23.44 | $23.44 |
Where Massachusetts sits
The same service costs 6.9 times more in Montana than in Indiana. 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· 14th of 51
$16.98
MT $28.18IN $4.07
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.