How much rates vary
Facilitymedian $5,370 · 10th to 90th $550 to $9,120Professionalmedian $2,089 · 10th to 90th $1,318 to $2,570
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 $2,137.96 Median $4,897.79 Typical High $6,918.31 | Facility | None | $2,137.96 | $4,897.79 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $1,584.89 Median $2,137.96 Typical High $2,344.23 | Professional | None | $1,584.89 | $2,137.96 | $2,344.23 |
Ambetter Setting Professional Modifier None Typical Low $2,754.23 Median $2,754.23 Typical High $2,754.23 | Professional | None | $2,754.23 | $2,754.23 | $2,754.23 |
BCBS Michigan Setting Facility Modifier None Typical Low $5,128.61 Median $5,754.40 Typical High $10,000.00 | Facility | None | $5,128.61 | $5,754.40 | $10,000.00 |
BCBS Michigan Setting Professional Modifier None Typical Low $426.58 Median $2,137.96 Typical High $2,290.87 | Professional | None | $426.58 | $2,137.96 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,202.26 Median $2,041.74 Typical High $2,454.71 | Professional | None | $1,202.26 | $2,041.74 | $2,454.71 |
Health Alliance Plan Setting Facility Modifier None Typical Low $2,089.30 Median $4,786.30 Typical High $5,754.40 | Facility | None | $2,089.30 | $4,786.30 | $5,754.40 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,659.59 Median $2,041.74 Typical High $2,344.23 | Professional | None | $1,659.59 | $2,041.74 | $2,344.23 |
Priority Health Setting Professional Modifier None Typical Low $1,122.02 Median $1,513.56 Typical High $2,454.71 | Professional | None | $1,122.02 | $1,513.56 | $2,454.71 |
United Setting Facility Modifier None Typical Low $426.58 Median $549.54 Typical High $3,311.31 | Facility | None | $426.58 | $549.54 | $3,311.31 |
United Setting Professional Modifier None Typical Low $1,862.09 Median $2,398.83 Typical High $2,951.21 | Professional | None | $1,862.09 | $2,398.83 | $2,951.21 |
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 $851.14 Median $1,071.52 Typical High $1,122.02 | Professional | 52 · Reduced service | $851.14 | $1,071.52 | $1,122.02 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $436.52 Typical High $446.68 | Professional | 53 · Discontinued | $338.84 | $436.52 | $446.68 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $1,621.81 Typical High $1,698.24 | Professional | 54 · Surgery only | $1,258.93 | $1,621.81 | $1,698.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $323.59 Typical High $338.84 | Professional | 55 · Aftercare only | $251.19 | $323.59 | $338.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $213.80 Typical High $223.87 | Professional | 56 · Pre-op care only | $169.82 | $213.80 | $223.87 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $1,023.29 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $1,023.29 | $1,047.13 | $1,047.13 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $407.38 Median $416.87 Typical High $416.87 | Professional | 53 · Discontinued | $407.38 | $416.87 | $416.87 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $1,513.56 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,513.56 | $1,584.89 | $1,584.89 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $302.00 Median $316.23 Typical High $316.23 | Professional | 55 · Aftercare only | $302.00 | $316.23 | $316.23 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $204.17 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $204.17 | $208.93 | $208.93 |
Where Michigan sits
The same service costs 24.1 times more in Maine 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
ME $53,525MD $2,222
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.