How much rates vary
Facilitymedian $155 · 10th to 90th $89 to $661Professionalmedian $46 · 10th to 90th $30 to $51
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 $44.67 Median $2,041.74 Typical High $4,897.79 | Facility | None | $44.67 | $2,041.74 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $37.15 Median $45.71 Typical High $51.29 | Professional | None | $37.15 | $45.71 | $51.29 |
Ambetter Setting Professional Modifier None Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | None | $30.20 | $30.20 | $30.20 |
BCBS Michigan Setting Facility Modifier None Typical Low $151.36 Median $154.88 Typical High $269.15 | Facility | None | $151.36 | $154.88 | $269.15 |
BCBS Michigan Setting Professional Modifier None Typical Low $9.33 Median $46.77 Typical High $50.12 | Professional | None | $9.33 | $46.77 | $50.12 |
Cigna Setting Facility Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Facility | None | $407.38 | $407.38 | $407.38 |
Cigna Setting Professional Modifier None Typical Low $26.30 Median $46.77 Typical High $117.49 | Professional | None | $26.30 | $46.77 | $117.49 |
Health Alliance Plan Setting Facility Modifier None Typical Low $79.43 Median $93.33 Typical High $4,897.79 | Facility | None | $79.43 | $93.33 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $35.48 Median $45.71 Typical High $54.95 | Professional | None | $35.48 | $45.71 | $54.95 |
Priority Health Setting Facility Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Facility | None | $407.38 | $407.38 | $407.38 |
Priority Health Setting Professional Modifier None Typical Low $26.30 Median $41.69 Typical High $107.15 | Professional | None | $26.30 | $41.69 | $107.15 |
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 $38.90 Median $43.65 Typical High $58.88 | Professional | None | $38.90 | $43.65 | $58.88 |
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 $20.89 Median $22.91 Typical High $23.99 | Professional | 52 · Reduced service | $20.89 | $22.91 | $23.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.32 Median $9.12 Typical High $9.55 | Professional | 53 · Discontinued | $8.32 | $9.12 | $9.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $30.90 Median $34.67 Typical High $35.48 | Professional | 54 · Surgery only | $30.90 | $34.67 | $35.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.31 Median $6.92 Typical High $7.08 | Professional | 55 · Aftercare only | $6.31 | $6.92 | $7.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.17 Median $4.57 Typical High $4.79 | Professional | 56 · Pre-op care only | $4.17 | $4.57 | $4.79 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $22.39 Median $23.44 Typical High $23.44 | Professional | 52 · Reduced service | $22.39 | $23.44 | $23.44 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $8.91 Median $9.33 Typical High $9.33 | Professional | 53 · Discontinued | $8.91 | $9.33 | $9.33 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $33.88 Median $34.67 Typical High $34.67 | Professional | 54 · Surgery only | $33.88 | $34.67 | $34.67 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $6.76 Median $7.08 Typical High $7.08 | Professional | 55 · Aftercare only | $6.76 | $7.08 | $7.08 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $4.47 Median $4.68 Typical High $4.68 | Professional | 56 · Pre-op care only | $4.47 | $4.68 | $4.68 |
Where Michigan sits
The same service costs 24.8 times more in New York 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
NY $2,664MT $107
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.