How much rates vary
Facilitymedian $1,000 · 10th to 90th $437 to $2,042Professionalmedian $331 · 10th to 90th $282 to $398
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 $331.13 Median $331.13 Typical High $6,918.31 | Facility | None | $331.13 | $331.13 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $275.42 Median $331.13 Typical High $331.13 | Professional | None | $275.42 | $331.13 | $331.13 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,000.00 Median $1,023.29 Typical High $1,737.80 | Facility | None | $1,000.00 | $1,023.29 | $1,737.80 |
BCBS Michigan Setting Professional Modifier None Typical Low $354.81 Median $371.54 Typical High $398.11 | Professional | None | $354.81 | $371.54 | $398.11 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $338.84 Typical High $794.33 | Professional | None | $208.93 | $338.84 | $794.33 |
Health Alliance Plan Setting Facility Modifier None Typical Low $331.13 Median $812.83 Typical High $4,897.79 | Facility | None | $331.13 | $812.83 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $281.84 Median $331.13 Typical High $426.58 | Professional | None | $281.84 | $331.13 | $426.58 |
Priority Health Setting Professional Modifier None Typical Low $208.93 Median $338.84 Typical High $467.74 | Professional | None | $208.93 | $338.84 | $467.74 |
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 $302.00 Median $331.13 Typical High $436.52 | Professional | None | $302.00 | $331.13 | $436.52 |
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 $144.54 Median $165.96 Typical High $165.96 | Professional | 52 · Reduced service | $144.54 | $165.96 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $57.54 Median $66.07 Typical High $66.07 | Professional | 53 · Discontinued | $57.54 | $66.07 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $218.78 Median $251.19 Typical High $251.19 | Professional | 54 · Surgery only | $218.78 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $43.65 Median $50.12 Typical High $50.12 | Professional | 55 · Aftercare only | $43.65 | $50.12 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.84 Median $33.11 Typical High $33.11 | Professional | 56 · Pre-op care only | $28.84 | $33.11 | $33.11 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $165.96 Median $165.96 Typical High $165.96 | Professional | 52 · Reduced service | $165.96 | $165.96 | $165.96 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $66.07 Median $66.07 Typical High $66.07 | Professional | 53 · Discontinued | $66.07 | $66.07 | $66.07 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $245.47 Median $245.47 Typical High $245.47 | Professional | 54 · Surgery only | $245.47 | $245.47 | $245.47 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $48.98 Median $48.98 Typical High $48.98 | Professional | 55 · Aftercare only | $48.98 | $48.98 | $48.98 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | 56 · Pre-op care only | $33.11 | $33.11 | $33.11 |
Where Michigan sits
The same service costs 32.0 times more in Maine than in Montana. 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 $26,674MT $834
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.