How much rates vary
Facilitymedian $437 · 10th to 90th $126 to $1,259Professionalmedian $170 · 10th to 90th $110 to $282
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 $125.89 Median $169.82 Typical High $4,897.79 | Facility | None | $125.89 | $169.82 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $125.89 Median $165.96 Typical High $204.17 | Professional | None | $125.89 | $165.96 | $204.17 |
Ambetter Setting Professional Modifier None Typical Low $81.28 Median $81.28 Typical High $81.28 | Professional | None | $81.28 | $81.28 | $81.28 |
BCBS Michigan Setting Facility Modifier None Typical Low $436.52 Median $436.52 Typical High $758.58 | Facility | None | $436.52 | $436.52 | $758.58 |
BCBS Michigan Setting Professional Modifier None Typical Low $23.44 Median $131.83 Typical High $144.54 | Professional | None | $23.44 | $131.83 | $144.54 |
CareSource Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | None | $177.83 | $177.83 | $177.83 |
Cigna Setting Professional Modifier None Typical Low $87.10 Median $151.36 Typical High $245.47 | Professional | None | $87.10 | $151.36 | $245.47 |
Health Alliance Plan Setting Facility Modifier None Typical Low $162.18 Median $588.84 Typical High $3,162.28 | Facility | None | $162.18 | $588.84 | $3,162.28 |
Health Alliance Plan Setting Professional Modifier None Typical Low $123.03 Median $213.80 Typical High $288.40 | Professional | None | $123.03 | $213.80 | $288.40 |
Priority Health Setting Professional Modifier None Typical Low $87.10 Median $151.36 Typical High $245.47 | Professional | None | $87.10 | $151.36 | $245.47 |
United Setting Facility Modifier None Typical Low $91.20 Median $177.83 Typical High $1,258.93 | Facility | None | $91.20 | $177.83 | $1,258.93 |
United Setting Professional Modifier None Typical Low $125.89 Median $218.78 Typical High $275.42 | Professional | None | $125.89 | $218.78 | $275.42 |
10 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 $63.10 Median $72.44 Typical High $85.11 | Professional | 52 · Reduced service | $63.10 | $72.44 | $85.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $29.51 Typical High $33.88 | Professional | 53 · Discontinued | $25.12 | $29.51 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $109.65 Typical High $125.89 | Professional | 54 · Surgery only | $93.33 | $109.65 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $21.88 Typical High $25.12 | Professional | 55 · Aftercare only | $19.05 | $21.88 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $14.79 Typical High $16.98 | Professional | 56 · Pre-op care only | $12.59 | $14.79 | $16.98 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $61.66 Median $61.66 Typical High $83.18 | Professional | 52 · Reduced service | $61.66 | $61.66 | $83.18 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $24.55 Typical High $33.11 | Professional | 53 · Discontinued | $24.55 | $24.55 | $33.11 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $93.33 Typical High $125.89 | Professional | 54 · Surgery only | $93.33 | $93.33 | $125.89 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $18.62 Typical High $25.12 | Professional | 55 · Aftercare only | $18.62 | $18.62 | $25.12 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $12.30 Typical High $16.60 | Professional | 56 · Pre-op care only | $12.30 | $12.30 | $16.60 |
Where Michigan sits
The same service costs 11.5 times more in Connecticut than in Maryland. 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.
Physician feeFacility fee
CT $2,992MD $261
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.