How much rates vary
Facilitymedian $3,631 · 10th to 90th $741 to $9,333Professionalmedian $380 · 10th to 90th $234 to $1,585
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 $281.84 Median $1,412.54 Typical High $4,073.80 | Facility | None | $281.84 | $1,412.54 | $4,073.80 |
Aetna Setting Professional Modifier None Typical Low $281.84 Median $389.05 Typical High $1,548.82 | Professional | None | $281.84 | $389.05 | $1,548.82 |
Ambetter Setting Professional Modifier None Typical Low $204.17 Median $1,148.15 Typical High $1,288.25 | Professional | None | $204.17 | $1,148.15 | $1,288.25 |
BCBS Michigan Setting Facility Modifier None Typical Low $3,235.94 Median $3,311.31 Typical High $5,623.41 | Facility | None | $3,235.94 | $3,311.31 | $5,623.41 |
BCBS Michigan Setting Professional Modifier None Typical Low $63.10 Median $316.23 Typical High $338.84 | Professional | None | $63.10 | $316.23 | $338.84 |
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 $213.80 Median $407.38 Typical High $1,905.46 | Professional | None | $213.80 | $407.38 | $1,905.46 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,380.38 Median $5,128.61 Typical High $9,772.37 | Facility | None | $1,380.38 | $5,128.61 | $9,772.37 |
Health Alliance Plan Setting Professional Modifier None Typical Low $275.42 Median $501.19 Typical High $1,584.89 | Professional | None | $275.42 | $501.19 | $1,584.89 |
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 $213.80 Median $371.54 Typical High $1,905.46 | Professional | None | $213.80 | $371.54 | $1,905.46 |
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 $288.40 Median $407.38 Typical High $1,698.24 | Professional | None | $288.40 | $407.38 | $1,698.24 |
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 $141.25 Median $549.54 Typical High $741.31 | Professional | 52 · Reduced service | $141.25 | $549.54 | $741.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $218.78 Typical High $302.00 | Professional | 53 · Discontinued | $56.23 | $218.78 | $302.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $812.83 Typical High $1,122.02 | Professional | 54 · Surgery only | $208.93 | $812.83 | $1,122.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $165.96 Typical High $223.87 | Professional | 55 · Aftercare only | $41.69 | $165.96 | $223.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $109.65 Typical High $151.36 | Professional | 56 · Pre-op care only | $28.18 | $109.65 | $151.36 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $138.04 Median $144.54 Typical High $794.33 | Professional | 52 · Reduced service | $138.04 | $144.54 | $794.33 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $54.95 Median $57.54 Typical High $316.23 | Professional | 53 · Discontinued | $54.95 | $57.54 | $316.23 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $204.17 Median $213.80 Typical High $1,174.90 | Professional | 54 · Surgery only | $204.17 | $213.80 | $1,174.90 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $42.66 Typical High $239.88 | Professional | 55 · Aftercare only | $41.69 | $42.66 | $239.88 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $27.54 Median $28.84 Typical High $158.49 | Professional | 56 · Pre-op care only | $27.54 | $28.84 | $158.49 |
Where Michigan sits
The same service costs 4.3 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 $8,043ME $1,891
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.