How much rates vary
Facilitymedian $2,884 · 10th to 90th $617 to $6,761Professionalmedian $603 · 10th to 90th $427 to $955
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 $512.86 Median $630.96 Typical High $4,897.79 | Facility | None | $512.86 | $630.96 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $426.58 Median $549.54 Typical High $660.69 | Professional | None | $426.58 | $549.54 | $660.69 |
Ambetter Setting Professional Modifier None Typical Low $436.52 Median $436.52 Typical High $436.52 | Professional | None | $436.52 | $436.52 | $436.52 |
BCBS Michigan Setting Facility Modifier None Typical Low $2,884.03 Median $2,884.03 Typical High $5,011.87 | Facility | None | $2,884.03 | $2,884.03 | $5,011.87 |
BCBS Michigan Setting Professional Modifier None Typical Low $398.11 Median $676.08 Typical High $954.99 | Professional | None | $398.11 | $676.08 | $954.99 |
Cigna Setting Facility Modifier None Typical Low $630.96 Median $630.96 Typical High $630.96 | Facility | None | $630.96 | $630.96 | $630.96 |
Cigna Setting Professional Modifier None Typical Low $398.11 Median $562.34 Typical High $1,202.26 | Professional | None | $398.11 | $562.34 | $1,202.26 |
Health Alliance Plan Setting Facility Modifier None Typical Low $537.03 Median $4,365.16 Typical High $8,912.51 | Facility | None | $537.03 | $4,365.16 | $8,912.51 |
Health Alliance Plan Setting Professional Modifier None Typical Low $501.19 Median $602.56 Typical High $741.31 | Professional | None | $501.19 | $602.56 | $741.31 |
Priority Health Setting Facility Modifier None Typical Low $630.96 Median $630.96 Typical High $630.96 | Facility | None | $630.96 | $630.96 | $630.96 |
Priority Health Setting Professional Modifier None Typical Low $371.54 Median $549.54 Typical High $954.99 | Professional | None | $371.54 | $549.54 | $954.99 |
United Setting Facility Modifier None Typical Low $602.56 Median $1,230.27 Typical High $5,248.07 | Facility | None | $602.56 | $1,230.27 | $5,248.07 |
United Setting Professional Modifier None Typical Low $446.68 Median $524.81 Typical High $724.44 | Professional | None | $446.68 | $524.81 | $724.44 |
13 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 $251.19 Median $263.03 Typical High $316.23 | Professional | 52 · Reduced service | $251.19 | $263.03 | $316.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $104.71 Typical High $125.89 | Professional | 53 · Discontinued | $100.00 | $104.71 | $125.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $380.19 Median $389.05 Typical High $478.63 | Professional | 54 · Surgery only | $380.19 | $389.05 | $478.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $75.86 Median $77.62 Typical High $95.50 | Professional | 55 · Aftercare only | $75.86 | $77.62 | $95.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $50.12 Median $52.48 Typical High $63.10 | Professional | 56 · Pre-op care only | $50.12 | $52.48 | $63.10 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $354.81 Median $363.08 Typical High $446.68 | Professional | 78 · Unplanned return to OR | $354.81 | $363.08 | $446.68 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $1,000.00 Median $1,380.38 Typical High $1,412.54 | Professional | 50 · Both sides | $1,000.00 | $1,380.38 | $1,412.54 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $245.47 Median $245.47 Typical High $302.00 | Professional | 52 · Reduced service | $245.47 | $245.47 | $302.00 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $100.00 Typical High $123.03 | Professional | 53 · Discontinued | $100.00 | $100.00 | $123.03 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $371.54 Median $371.54 Typical High $457.09 | Professional | 54 · Surgery only | $371.54 | $371.54 | $457.09 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $74.13 Median $74.13 Typical High $91.20 | Professional | 55 · Aftercare only | $74.13 | $74.13 | $91.20 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $50.12 Median $50.12 Typical High $60.26 | Professional | 56 · Pre-op care only | $50.12 | $50.12 | $60.26 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $346.74 Median $346.74 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $346.74 | $346.74 | $426.58 |
Where Michigan sits
The same service costs 7.2 times more in Vermont 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
VT $9,370ME $1,294
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.