How much rates vary
Facilitymedian $5,248 · 10th to 90th $501 to $8,128Professionalmedian $1,862 · 10th to 90th $1,175 to $2,692
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 $1,862.09 Median $1,905.46 Typical High $6,918.31 | Facility | None | $1,862.09 | $1,905.46 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $1,513.56 Median $1,905.46 Typical High $1,995.26 | Professional | None | $1,513.56 | $1,905.46 | $1,995.26 |
BCBS Michigan Setting Facility Modifier None Typical Low $5,248.07 Median $5,248.07 Typical High $9,120.11 | Facility | None | $5,248.07 | $5,248.07 | $9,120.11 |
BCBS Michigan Setting Professional Modifier None Typical Low $316.23 Median $1,862.09 Typical High $2,818.38 | Professional | None | $316.23 | $1,862.09 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $1,071.52 Median $1,862.09 Typical High $2,137.96 | Professional | None | $1,071.52 | $1,862.09 | $2,137.96 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,819.70 Median $4,570.88 Typical High $4,897.79 | Facility | None | $1,819.70 | $4,570.88 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,548.82 Median $1,819.70 Typical High $2,187.76 | Professional | None | $1,548.82 | $1,819.70 | $2,187.76 |
Priority Health Setting Professional Modifier None Typical Low $1,000.00 Median $1,862.09 Typical High $2,630.27 | Professional | None | $1,000.00 | $1,862.09 | $2,630.27 |
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 $1,698.24 Median $2,137.96 Typical High $2,454.71 | Professional | None | $1,698.24 | $2,137.96 | $2,454.71 |
13 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 $758.58 Median $954.99 Typical High $1,000.00 | Professional | 52 · Reduced service | $758.58 | $954.99 | $1,000.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $380.19 Typical High $398.11 | Professional | 53 · Discontinued | $302.00 | $380.19 | $398.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $1,412.54 Typical High $1,479.11 | Professional | 54 · Surgery only | $1,122.02 | $1,412.54 | $1,479.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $281.84 Typical High $295.12 | Professional | 55 · Aftercare only | $229.09 | $281.84 | $295.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $190.55 Typical High $199.53 | Professional | 56 · Pre-op care only | $151.36 | $190.55 | $199.53 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,318.26 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,318.26 | $1,380.38 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $3,019.95 Median $3,019.95 Typical High $3,019.95 | Professional | 50 · Both sides | $3,019.95 | $3,019.95 | $3,019.95 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $912.01 Median $933.25 Typical High $933.25 | Professional | 52 · Reduced service | $912.01 | $933.25 | $933.25 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $363.08 Median $380.19 Typical High $380.19 | Professional | 53 · Discontinued | $363.08 | $380.19 | $380.19 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $1,348.96 Median $1,412.54 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,348.96 | $1,412.54 | $1,412.54 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $281.84 Typical High $281.84 | Professional | 55 · Aftercare only | $269.15 | $281.84 | $281.84 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $181.97 Median $186.21 Typical High $186.21 | Professional | 56 · Pre-op care only | $181.97 | $186.21 | $186.21 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $1,318.26 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,258.93 | $1,318.26 | $1,318.26 |
Where Michigan sits
The same service costs 7.5 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 $16,075MD $2,147
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.