How much rates vary
Facilitymedian $3,548 · 10th to 90th $1,072 to $6,166Professionalmedian $1,380 · 10th to 90th $912 to $1,549
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 $1,348.96 Median $2,884.03 Typical High $4,897.79 | Facility | None | $1,348.96 | $2,884.03 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $1,348.96 Median $1,380.38 Typical High $1,412.54 | Professional | None | $1,348.96 | $1,380.38 | $1,412.54 |
BCBS Michigan Setting Facility Modifier None Typical Low $3,548.13 Median $3,548.13 Typical High $6,165.95 | Facility | None | $3,548.13 | $3,548.13 | $6,165.95 |
BCBS Michigan Setting Professional Modifier None Typical Low $295.12 Median $1,445.44 Typical High $1,548.82 | Professional | None | $295.12 | $1,445.44 | $1,548.82 |
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 $812.83 Median $1,258.93 Typical High $2,344.23 | Professional | None | $812.83 | $1,258.93 | $2,344.23 |
Health Alliance Plan Setting Facility Modifier None Typical Low $2,041.74 Median $2,884.03 Typical High $4,897.79 | Facility | None | $2,041.74 | $2,884.03 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,096.48 Median $1,380.38 Typical High $1,548.82 | Professional | None | $1,096.48 | $1,380.38 | $1,548.82 |
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 $812.83 Median $1,174.90 Typical High $1,819.70 | Professional | None | $812.83 | $1,174.90 | $1,819.70 |
United Setting Facility Modifier None Typical Low $851.14 Median $2,238.72 Typical High $7,762.47 | Facility | None | $851.14 | $2,238.72 | $7,762.47 |
United Setting Professional Modifier None Typical Low $1,122.02 Median $1,258.93 Typical High $1,412.54 | Professional | None | $1,122.02 | $1,258.93 | $1,412.54 |
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 $676.08 Median $691.83 Typical High $691.83 | Professional | 52 · Reduced service | $676.08 | $691.83 | $691.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $275.42 Typical High $275.42 | Professional | 53 · Discontinued | $269.15 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,047.13 Typical High $1,047.13 | Professional | 54 · Surgery only | $1,023.29 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $208.93 Typical High $208.93 | Professional | 55 · Aftercare only | $204.17 | $208.93 | $208.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $138.04 Typical High $138.04 | Professional | 56 · Pre-op care only | $134.90 | $138.04 | $138.04 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $977.24 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $954.99 | $977.24 | $977.24 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $676.08 Median $707.95 Typical High $707.95 | Professional | 52 · Reduced service | $676.08 | $707.95 | $707.95 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $281.84 Typical High $281.84 | Professional | 53 · Discontinued | $269.15 | $281.84 | $281.84 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,047.13 Typical High $1,047.13 | Professional | 54 · Surgery only | $1,000.00 | $1,047.13 | $1,047.13 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $208.93 Typical High $208.93 | Professional | 55 · Aftercare only | $204.17 | $208.93 | $208.93 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $141.25 Typical High $141.25 | Professional | 56 · Pre-op care only | $134.90 | $141.25 | $141.25 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $977.24 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $933.25 | $977.24 | $977.24 |
Where Michigan sits
The same service costs 5.3 times more in Vermont than in Hawaii. 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 $13,652HI $2,577
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.