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 $91.20 Median $91.20 Typical High $91.20 | Facility | None | $91.20 | $91.20 | $91.20 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $91.20 Typical High $114.82 | Professional | None | $91.20 | $91.20 | $114.82 |
AllWays Health Partners Setting Facility Modifier None Typical Low $134.90 Median $134.90 Typical High $426.58 | Facility | None | $134.90 | $134.90 | $426.58 |
AllWays Health Partners Setting Professional Modifier None Typical Low $70.79 Median $117.49 Typical High $724.44 | Professional | None | $70.79 | $117.49 | $724.44 |
BCBS Massachusetts Setting Facility Modifier None Typical Low $162.18 Median $186.21 Typical High $245.47 | Facility | None | $162.18 | $186.21 | $245.47 |
Cigna Setting Professional Modifier None Typical Low $58.88 Median $58.88 Typical High $58.88 | Professional | None | $58.88 | $58.88 | $58.88 |
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 $67.61 Median $125.89 Typical High $125.89 | Professional | None | $67.61 | $125.89 | $125.89 |
Mass General Brigham Setting Facility Modifier None Typical Low $134.90 Median $134.90 Typical High $426.58 | Facility | None | $134.90 | $134.90 | $426.58 |
Mass General Brigham Setting Professional Modifier None Typical Low $70.79 Median $117.49 Typical High $724.44 | Professional | None | $70.79 | $117.49 | $724.44 |
United Setting Professional Modifier None Typical Low $47.86 Median $70.79 Typical High $100.00 | Professional | None | $47.86 | $70.79 | $100.00 |
Well Sense Setting Facility Modifier None Typical Low $114.82 Median $158.49 Typical High $234.42 | Facility | None | $114.82 | $158.49 | $234.42 |
Well Sense Setting Professional Modifier None Typical Low $223.87 Median $2,511.89 Typical High $3,019.95 | Professional | None | $223.87 | $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 $45.71 Median $45.71 Typical High $57.54 | Professional | 52 · Reduced service | $45.71 | $45.71 | $57.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $18.20 Typical High $22.91 | Professional | 53 · Discontinued | $18.20 | $18.20 | $22.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $13.49 Typical High $17.38 | Professional | 55 · Aftercare only | $13.49 | $13.49 | $17.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $9.12 Typical High $11.48 | Professional | 56 · Pre-op care only | $9.12 | $9.12 | $11.48 |
Where Massachusetts sits
The same service costs 3.0 times more in California 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· 28th of 51
$100
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.