How much rates vary
Facilitymedian $513 · 10th to 90th $126 to $1,047Professionalmedian $155 · 10th to 90th $91 to $229
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 $147.91 Median $2,041.74 Typical High $4,897.79 | Facility | None | $147.91 | $2,041.74 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $138.04 Median $151.36 Typical High $154.88 | Professional | None | $138.04 | $151.36 | $154.88 |
BCBS Michigan Setting Facility Modifier None Typical Low $512.86 Median $512.86 Typical High $891.25 | Facility | None | $512.86 | $512.86 | $891.25 |
BCBS Michigan Setting Professional Modifier None Typical Low $30.20 Median $151.36 Typical High $229.09 | Professional | None | $30.20 | $151.36 | $229.09 |
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 $89.13 Median $151.36 Typical High $446.68 | Professional | None | $89.13 | $151.36 | $446.68 |
Health Alliance Plan Setting Facility Modifier None Typical Low $346.74 Median $426.58 Typical High $4,897.79 | Facility | None | $346.74 | $426.58 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $134.90 Median $158.49 Typical High $194.98 | Professional | None | $134.90 | $158.49 | $194.98 |
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 $89.13 Median $151.36 Typical High $218.78 | Professional | None | $89.13 | $151.36 | $218.78 |
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 $141.25 Median $154.88 Typical High $204.17 | Professional | None | $141.25 | $154.88 | $204.17 |
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 $69.18 Median $75.86 Typical High $77.62 | Professional | 52 · Reduced service | $69.18 | $75.86 | $77.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $27.54 Median $30.20 Typical High $30.90 | Professional | 53 · Discontinued | $27.54 | $30.20 | $30.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $104.71 Median $112.20 Typical High $114.82 | Professional | 54 · Surgery only | $104.71 | $112.20 | $114.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.89 Median $22.39 Typical High $22.91 | Professional | 55 · Aftercare only | $20.89 | $22.39 | $22.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $15.14 Typical High $15.49 | Professional | 56 · Pre-op care only | $13.80 | $15.14 | $15.49 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $75.86 Median $79.43 Typical High $79.43 | Professional | 52 · Reduced service | $75.86 | $79.43 | $79.43 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $31.62 Typical High $31.62 | Professional | 53 · Discontinued | $30.20 | $31.62 | $31.62 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $114.82 Median $117.49 Typical High $117.49 | Professional | 54 · Surgery only | $114.82 | $117.49 | $117.49 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $22.91 Median $23.44 Typical High $23.44 | Professional | 55 · Aftercare only | $22.91 | $23.44 | $23.44 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $15.85 Typical High $15.85 | Professional | 56 · Pre-op care only | $15.14 | $15.85 | $15.85 |
Where Michigan sits
The same service costs 8.9 times more in New York 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
NY $2,750MD $308
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.