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 $11.75 Median $11.75 Typical High $11.75 | Facility | None | $11.75 | $11.75 | $11.75 |
Aetna Setting Professional Modifier None Typical Low $11.75 Median $11.75 Typical High $19.95 | Professional | None | $11.75 | $11.75 | $19.95 |
AllWays Health Partners Setting Professional Modifier None Typical Low $10.00 Median $15.85 Typical High $398.11 | Professional | None | $10.00 | $15.85 | $398.11 |
BCBS Massachusetts Setting Professional Modifier None Typical Low $26.30 Median $26.30 Typical High $26.30 | Professional | None | $26.30 | $26.30 | $26.30 |
Cigna Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $14.13 | Professional | None | $10.72 | $10.72 | $14.13 |
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 $10.00 Median $22.39 Typical High $25.12 | Professional | None | $10.00 | $22.39 | $25.12 |
Health New England Setting Facility Modifier None Typical Low $16.22 Median $16.22 Typical High $32.36 | Facility | None | $16.22 | $16.22 | $32.36 |
Health New England Setting Professional Modifier None Typical Low $16.22 Median $16.22 Typical High $16.22 | Professional | None | $16.22 | $16.22 | $16.22 |
Mass General Brigham Setting Professional Modifier None Typical Low $10.00 Median $15.85 Typical High $398.11 | Professional | None | $10.00 | $15.85 | $398.11 |
United Setting Professional Modifier None Typical Low $8.51 Median $12.88 Typical High $25.12 | Professional | None | $8.51 | $12.88 | $25.12 |
Well Sense Setting Facility Modifier None Typical Low $16.98 Median $23.44 Typical High $34.67 | Facility | None | $16.98 | $23.44 | $34.67 |
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 |
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 $5.89 Median $5.89 Typical High $9.33 | Professional | 52 · Reduced service | $5.89 | $5.89 | $9.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.34 Median $2.34 Typical High $3.72 | Professional | 53 · Discontinued | $2.34 | $2.34 | $3.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $8.91 Median $8.91 Typical High $13.80 | Professional | 54 · Surgery only | $8.91 | $8.91 | $13.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.78 Median $1.78 Typical High $2.75 | Professional | 55 · Aftercare only | $1.78 | $1.78 | $2.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.20 Median $1.20 Typical High $1.86 | Professional | 56 · Pre-op care only | $1.20 | $1.20 | $1.86 |
Where Massachusetts sits
The same service costs 3.5 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· 40th 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.