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 $89.13 Median $89.13 Typical High $89.13 | Facility | None | $89.13 | $89.13 | $89.13 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $89.13 Typical High $97.72 | Professional | None | $89.13 | $89.13 | $97.72 |
AllWays Health Partners Setting Facility Modifier None Typical Low $125.89 Median $151.36 Typical High $457.09 | Facility | None | $125.89 | $151.36 | $457.09 |
AllWays Health Partners Setting Professional Modifier None Typical Low $125.89 Median $151.36 Typical High $660.69 | Professional | None | $125.89 | $151.36 | $660.69 |
Cigna Setting Facility Modifier None Typical Low $162.18 Median $229.09 Typical High $389.05 | Facility | None | $162.18 | $229.09 | $389.05 |
Cigna Setting Professional Modifier None Typical Low $125.89 Median $125.89 Typical High $125.89 | Professional | None | $125.89 | $125.89 | $125.89 |
Fallon Health Setting Facility Modifier None Typical Low $147.91 Median $181.97 Typical High $363.08 | Facility | None | $147.91 | $181.97 | $363.08 |
Fallon Health Setting Professional Modifier None Typical Low $169.82 Median $199.53 Typical High $234.42 | Professional | None | $169.82 | $199.53 | $234.42 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $125.89 Median $125.89 Typical High $141.25 | Professional | None | $125.89 | $125.89 | $141.25 |
Mass General Brigham Setting Facility Modifier None Typical Low $125.89 Median $151.36 Typical High $457.09 | Facility | None | $125.89 | $151.36 | $457.09 |
Mass General Brigham Setting Professional Modifier None Typical Low $125.89 Median $151.36 Typical High $660.69 | Professional | None | $125.89 | $151.36 | $660.69 |
United Setting Professional Modifier None Typical Low $125.89 Median $125.89 Typical High $141.25 | Professional | None | $125.89 | $125.89 | $141.25 |
Well Sense Setting Facility Modifier None Typical Low $2,511.89 Median $3,467.37 Typical High $5,128.61 | Facility | None | $2,511.89 | $3,467.37 | $5,128.61 |
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 $43.65 Median $43.65 Typical High $48.98 | Professional | 52 · Reduced service | $43.65 | $43.65 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.78 Median $17.78 Typical High $19.50 | Professional | 53 · Discontinued | $17.78 | $17.78 | $19.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.18 Median $13.18 Typical High $14.45 | Professional | 55 · Aftercare only | $13.18 | $13.18 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $8.71 Typical High $9.77 | Professional | 56 · Pre-op care only | $8.71 | $8.71 | $9.77 |
Where Massachusetts sits
The same service costs 5.5 times more in North Dakota than in Kentucky. 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· 13th of 51
$126
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.