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 $1.95 Median $1.95 Typical High $1.95 | Facility | None | $1.95 | $1.95 | $1.95 |
Aetna Setting Professional Modifier None Typical Low $1.95 Median $1.95 Typical High $3.02 | Professional | None | $1.95 | $1.95 | $3.02 |
AllWays Health Partners Setting Professional Modifier None Typical Low $1.66 Median $2.69 Typical High $74.13 | Professional | None | $1.66 | $2.69 | $74.13 |
BCBS Massachusetts Setting Professional Modifier None Typical Low $4.27 Median $4.27 Typical High $4.27 | Professional | None | $4.27 | $4.27 | $4.27 |
Cigna Setting Professional Modifier None Typical Low $1.78 Median $1.78 Typical High $2.34 | Professional | None | $1.78 | $1.78 | $2.34 |
Fallon Health Setting Facility Modifier None Typical Low $83.18 Median $3,630.78 Typical High $9,772.37 | Facility | None | $83.18 | $3,630.78 | $9,772.37 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1.66 Median $3.72 Typical High $4.17 | Professional | None | $1.66 | $3.72 | $4.17 |
Mass General Brigham Setting Professional Modifier None Typical Low $1.66 Median $2.69 Typical High $74.13 | Professional | None | $1.66 | $2.69 | $74.13 |
United Setting Professional Modifier None Typical Low $1.41 Median $2.09 Typical High $4.17 | Professional | None | $1.41 | $2.09 | $4.17 |
Well Sense Setting Facility Modifier None Typical Low $2.69 Median $3.72 Typical High $5.50 | Facility | None | $2.69 | $3.72 | $5.50 |
Well Sense Setting Professional Modifier None Typical Low $6,456.54 Median $6,456.54 Typical High $7,762.47 | Professional | None | $6,456.54 | $6,456.54 | $7,762.47 |
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 $0.98 Median $0.98 Typical High $1.55 | Professional | 52 · Reduced service | $0.98 | $0.98 | $1.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.39 Median $0.39 Typical High $0.62 | Professional | 53 · Discontinued | $0.39 | $0.39 | $0.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1.45 Median $1.45 Typical High $2.29 | Professional | 54 · Surgery only | $1.45 | $1.45 | $2.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.28 Median $0.28 Typical High $0.46 | Professional | 55 · Aftercare only | $0.28 | $0.28 | $0.46 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.20 Median $0.20 Typical High $0.31 | Professional | 56 · Pre-op care only | $0.20 | $0.20 | $0.31 |
Where Massachusetts sits
The same service costs 4.0 times more in Rhode Island than in New York. 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· 39th of 51
$2.34
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.