How much rates vary
Facilitymedian $1,122 · 10th to 90th $331 to $3,467Professionalmedian $275 · 10th to 90th $151 to $525
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 $181.97 Median $316.23 Typical High $2,884.03 | Facility | None | $181.97 | $316.23 | $2,884.03 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $63.10 Median $95.50 Typical High $169.82 | Facility | 53 · Discontinued | $63.10 | $95.50 | $169.82 |
Aetna Setting Professional Modifier None Typical Low $177.83 Median $316.23 Typical High $346.74 | Professional | None | $177.83 | $316.23 | $346.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $91.20 Typical High $165.96 | Professional | 53 · Discontinued | $37.15 | $91.20 | $165.96 |
Ambetter Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $245.47 | Professional | None | $162.18 | $162.18 | $245.47 |
BCBS Michigan Setting Facility Modifier None Typical Low $794.33 Median $1,023.29 Typical High $2,511.89 | Facility | None | $794.33 | $1,023.29 | $2,511.89 |
BCBS Michigan Setting Professional Modifier None Typical Low $43.65 Median $158.49 Typical High $275.42 | Professional | None | $43.65 | $158.49 | $275.42 |
CareSource Setting Professional Modifier None Typical Low $48.98 Median $61.66 Typical High $436.52 | Professional | None | $48.98 | $61.66 | $436.52 |
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 $302.00 Median $302.00 Typical High $371.54 | Professional | None | $302.00 | $302.00 | $371.54 |
Health Alliance Plan Setting Facility Modifier None Typical Low $389.05 Median $1,737.80 Typical High $3,548.13 | Facility | None | $389.05 | $1,737.80 | $3,548.13 |
Health Alliance Plan Setting Facility Modifier 53 · Discontinued Typical Low $89.13 Median $158.49 Typical High $380.19 | Facility | 53 · Discontinued | $89.13 | $158.49 | $380.19 |
Health Alliance Plan Setting Professional Modifier None Typical Low $186.21 Median $338.84 Typical High $537.03 | Professional | None | $186.21 | $338.84 | $537.03 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $131.83 Typical High $186.21 | Professional | 53 · Discontinued | $37.15 | $131.83 | $186.21 |
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 $302.00 Median $302.00 Typical High $436.52 | Professional | None | $302.00 | $302.00 | $436.52 |
United Setting Facility Modifier None Typical Low $288.40 Median $426.58 Typical High $2,089.30 | Facility | None | $288.40 | $426.58 | $2,089.30 |
United Setting Professional Modifier None Typical Low $234.42 Median $346.74 Typical High $588.84 | Professional | None | $234.42 | $346.74 | $588.84 |
8 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 $89.13 Median $95.50 Typical High $165.96 | Professional | 52 · Reduced service | $89.13 | $95.50 | $165.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $181.97 Typical High $251.19 | Professional | 54 · Surgery only | $134.90 | $181.97 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $35.48 Typical High $50.12 | Professional | 55 · Aftercare only | $26.92 | $35.48 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $23.99 Typical High $33.11 | Professional | 56 · Pre-op care only | $17.78 | $23.99 | $33.11 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $91.20 Median $102.33 Typical High $169.82 | Professional | 52 · Reduced service | $91.20 | $102.33 | $169.82 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $169.82 Typical High $251.19 | Professional | 54 · Surgery only | $138.04 | $169.82 | $251.19 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $33.88 Typical High $50.12 | Professional | 55 · Aftercare only | $27.54 | $33.88 | $50.12 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $22.39 Typical High $33.88 | Professional | 56 · Pre-op care only | $18.20 | $22.39 | $33.88 |
Where Michigan sits
The same service costs 5.8 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 $4,478ME $766
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.