How much rates vary
Facilitymedian $234 · 10th to 90th $91 to $562Professionalmedian $112 · 10th to 90th $63 to $191
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 $72.44 Median $131.83 Typical High $169.82 | Facility | None | $72.44 | $131.83 | $169.82 |
Aetna Setting Professional Modifier None Typical Low $72.44 Median $104.71 Typical High $141.25 | Professional | None | $72.44 | $104.71 | $141.25 |
Ambetter Setting Professional Modifier None Typical Low $63.10 Median $63.10 Typical High $112.20 | Professional | None | $63.10 | $63.10 | $112.20 |
BCBS Michigan Setting Facility Modifier None Typical Low $173.78 Median $218.78 Typical High $537.03 | Facility | None | $173.78 | $218.78 | $537.03 |
BCBS Michigan Setting Professional Modifier None Typical Low $17.78 Median $89.13 Typical High $229.09 | Professional | None | $17.78 | $89.13 | $229.09 |
CareSource Setting Professional Modifier None Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | None | $141.25 | $141.25 | $141.25 |
Cigna Setting Professional Modifier None Typical Low $48.98 Median $93.33 Typical High $165.96 | Professional | None | $48.98 | $93.33 | $165.96 |
Health Alliance Plan Setting Facility Modifier None Typical Low $112.20 Median $263.03 Typical High $524.81 | Facility | None | $112.20 | $263.03 | $524.81 |
Health Alliance Plan Setting Professional Modifier None Typical Low $70.79 Median $131.83 Typical High $173.78 | Professional | None | $70.79 | $131.83 | $173.78 |
Priority Health Setting Professional Modifier None Typical Low $48.98 Median $93.33 Typical High $165.96 | Professional | None | $48.98 | $93.33 | $165.96 |
United Setting Facility Modifier None Typical Low $91.20 Median $177.83 Typical High $1,202.26 | Facility | None | $91.20 | $177.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $69.18 Median $125.89 Typical High $173.78 | Professional | None | $69.18 | $125.89 | $173.78 |
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 $36.31 Median $48.98 Typical High $67.61 | Professional | 52 · Reduced service | $36.31 | $48.98 | $67.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.45 Median $19.50 Typical High $26.92 | Professional | 53 · Discontinued | $14.45 | $19.50 | $26.92 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $53.70 Median $74.13 Typical High $100.00 | Professional | 54 · Surgery only | $53.70 | $74.13 | $100.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.72 Median $14.79 Typical High $20.42 | Professional | 55 · Aftercare only | $10.72 | $14.79 | $20.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.24 Median $9.77 Typical High $13.49 | Professional | 56 · Pre-op care only | $7.24 | $9.77 | $13.49 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $35.48 Median $46.77 Typical High $66.07 | Professional | 52 · Reduced service | $35.48 | $46.77 | $66.07 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $14.13 Median $18.62 Typical High $26.30 | Professional | 53 · Discontinued | $14.13 | $18.62 | $26.30 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $52.48 Median $72.44 Typical High $100.00 | Professional | 54 · Surgery only | $52.48 | $72.44 | $100.00 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $10.47 Median $14.13 Typical High $19.95 | Professional | 55 · Aftercare only | $10.47 | $14.13 | $19.95 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $7.08 Median $9.33 Typical High $13.18 | Professional | 56 · Pre-op care only | $7.08 | $9.33 | $13.18 |
Where Michigan sits
The same service costs 12.9 times more in Colorado than in Maine. 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
CO $2,408ME $187
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.