How much rates vary
Facilitymedian $1,950 · 10th to 90th $631 to $4,169Professionalmedian $457 · 10th to 90th $302 to $646
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 $407.38 Median $616.60 Typical High $4,897.79 | Facility | None | $407.38 | $616.60 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $263.03 Median $416.87 Typical High $602.56 | Professional | None | $263.03 | $416.87 | $602.56 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $3,388.44 | Facility | None | $1,949.84 | $1,949.84 | $3,388.44 |
BCBS Michigan Setting Professional Modifier None Typical Low $95.50 Median $512.86 Typical High $724.44 | Professional | None | $95.50 | $512.86 | $724.44 |
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 $257.04 Median $457.09 Typical High $851.14 | Professional | None | $257.04 | $457.09 | $851.14 |
Health Alliance Plan Setting Facility Modifier None Typical Low $489.78 Median $1,258.93 Typical High $5,754.40 | Facility | None | $489.78 | $1,258.93 | $5,754.40 |
Health Alliance Plan Setting Professional Modifier None Typical Low $309.03 Median $457.09 Typical High $630.96 | Professional | None | $309.03 | $457.09 | $630.96 |
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 $239.88 Median $407.38 Typical High $660.69 | Professional | None | $239.88 | $407.38 | $660.69 |
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 $346.74 Median $457.09 Typical High $602.56 | Professional | None | $346.74 | $457.09 | $602.56 |
12 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 $204.17 Median $218.78 Typical High $302.00 | Professional | 52 · Reduced service | $204.17 | $218.78 | $302.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $87.10 Typical High $120.23 | Professional | 53 · Discontinued | $81.28 | $87.10 | $120.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $323.59 Typical High $457.09 | Professional | 54 · Surgery only | $309.03 | $323.59 | $457.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $64.57 Typical High $91.20 | Professional | 55 · Aftercare only | $61.66 | $64.57 | $91.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $43.65 Typical High $60.26 | Professional | 56 · Pre-op care only | $40.74 | $43.65 | $60.26 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $302.00 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $288.40 | $302.00 | $426.58 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $204.17 Median $213.80 Typical High $316.23 | Professional | 52 · Reduced service | $204.17 | $213.80 | $316.23 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $85.11 Typical High $125.89 | Professional | 53 · Discontinued | $81.28 | $85.11 | $125.89 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $316.23 Typical High $467.74 | Professional | 54 · Surgery only | $309.03 | $316.23 | $467.74 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $63.10 Typical High $93.33 | Professional | 55 · Aftercare only | $61.66 | $63.10 | $93.33 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $42.66 Typical High $63.10 | Professional | 56 · Pre-op care only | $40.74 | $42.66 | $63.10 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $295.12 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $288.40 | $295.12 | $436.52 |
Where Michigan sits
The same service costs 11.0 times more in Vermont than in Montana. 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 $12,892MT $1,170
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.