How much rates vary
Facilitymedian $1,000 · 10th to 90th $447 to $3,631Professionalmedian $204 · 10th to 90th $60 to $513
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 $173.78 Median $446.68 Typical High $616.60 | Facility | None | $173.78 | $446.68 | $616.60 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $316.23 Typical High $446.68 | Professional | None | $173.78 | $316.23 | $446.68 |
Ambetter Setting Professional Modifier None Typical Low $60.26 Median $120.23 Typical High $354.81 | Professional | None | $60.26 | $120.23 | $354.81 |
BCBS Michigan Setting Facility Modifier None Typical Low $851.14 Median $870.96 Typical High $1,513.56 | Facility | None | $851.14 | $870.96 | $1,513.56 |
BCBS Michigan Setting Professional Modifier None Typical Low $32.36 Median $190.55 Typical High $691.83 | Professional | None | $32.36 | $190.55 | $691.83 |
CareSource Setting Professional Modifier None Typical Low $323.59 Median $457.09 Typical High $537.03 | Professional | None | $323.59 | $457.09 | $537.03 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $549.54 Typical High $549.54 | Facility | None | $549.54 | $549.54 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $141.25 Median $309.03 Typical High $588.84 | Professional | None | $141.25 | $309.03 | $588.84 |
Health Alliance Plan Setting Facility Modifier None Typical Low $512.86 Median $1,258.93 Typical High $3,981.07 | Facility | None | $512.86 | $1,258.93 | $3,981.07 |
Health Alliance Plan Setting Professional Modifier None Typical Low $173.78 Median $407.38 Typical High $512.86 | Professional | None | $173.78 | $407.38 | $512.86 |
Priority Health Setting Facility Modifier None Typical Low $549.54 Median $549.54 Typical High $549.54 | Facility | None | $549.54 | $549.54 | $549.54 |
Priority Health Setting Professional Modifier None Typical Low $141.25 Median $309.03 Typical High $524.81 | Professional | None | $141.25 | $309.03 | $524.81 |
United Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $2,951.21 | Facility | None | $426.58 | $602.56 | $2,951.21 |
United Setting Professional Modifier None Typical Low $173.78 Median $323.59 Typical High $537.03 | Professional | None | $173.78 | $323.59 | $537.03 |
19 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 $87.10 Median $165.96 Typical High $223.87 | Professional | 52 · Reduced service | $87.10 | $165.96 | $223.87 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $66.07 Typical High $89.13 | Professional | 53 · Discontinued | $34.67 | $66.07 | $89.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $251.19 Typical High $338.84 | Professional | 54 · Surgery only | $128.82 | $251.19 | $338.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $50.12 Typical High $67.61 | Professional | 55 · Aftercare only | $25.70 | $50.12 | $67.61 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $33.11 Typical High $44.67 | Professional | 56 · Pre-op care only | $17.38 | $33.11 | $44.67 |
Ambetter Setting Professional Modifier 22 · Increased work Typical Low $128.82 Median $128.82 Typical High $128.82 | Professional | 22 · Increased work | $128.82 | $128.82 | $128.82 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $120.23 Median $120.23 Typical High $144.54 | Professional | 59 · Distinct service | $120.23 | $120.23 | $144.54 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $389.05 Median $389.05 Typical High $389.05 | Professional | Q6 · Substitute physician, paid per time | $389.05 | $389.05 | $389.05 |
Ambetter Setting Professional Modifier XS · Separate structure Typical Low $64.57 Median $64.57 Typical High $64.57 | Professional | XS · Separate structure | $64.57 | $64.57 | $64.57 |
Ambetter Setting Professional Modifier XU · Unusual separate service Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | XU · Unusual separate service | $60.26 | $60.26 | $60.26 |
Health Alliance Plan Setting Professional Modifier 51 · Multiple procedures Typical Low $74.13 Median $173.78 Typical High $489.78 | Professional | 51 · Multiple procedures | $74.13 | $173.78 | $489.78 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $87.10 Median $104.71 Typical High $234.42 | Professional | 52 · Reduced service | $87.10 | $104.71 | $234.42 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $41.69 Typical High $93.33 | Professional | 53 · Discontinued | $34.67 | $41.69 | $93.33 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $158.49 Typical High $346.74 | Professional | 54 · Surgery only | $131.83 | $158.49 | $346.74 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $31.62 Typical High $69.18 | Professional | 55 · Aftercare only | $26.30 | $31.62 | $69.18 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $20.89 Typical High $46.77 | Professional | 56 · Pre-op care only | $17.38 | $20.89 | $46.77 |
Health Alliance Plan Setting Professional Modifier 59 · Distinct service Typical Low $12.88 Median $33.11 Typical High $131.83 | Professional | 59 · Distinct service | $12.88 | $33.11 | $131.83 |
Health Alliance Plan Setting Professional Modifier GC · Resident with teaching physician Typical Low $63.10 Median $131.83 Typical High $263.03 | Professional | GC · Resident with teaching physician | $63.10 | $131.83 | $263.03 |
Health Alliance Plan Setting Professional Modifier XS · Separate structure Typical Low $15.49 Median $57.54 Typical High $263.03 | Professional | XS · Separate structure | $15.49 | $57.54 | $263.03 |
Where Michigan sits
The same service costs 4.2 times more in Vermont 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
VT $3,301MD $784
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.