How much rates vary
Facilitymedian $5,248 · 10th to 90th $1,202 to $8,511Professionalmedian $1,778 · 10th to 90th $1,259 to $2,089
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 $1,819.70 Median $1,905.46 Typical High $6,918.31 | Facility | None | $1,819.70 | $1,905.46 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $1,479.11 Median $1,819.70 Typical High $1,905.46 | Professional | None | $1,479.11 | $1,819.70 | $1,905.46 |
Ambetter Setting Professional Modifier None Typical Low $1,380.38 Median $1,380.38 Typical High $1,380.38 | Professional | None | $1,380.38 | $1,380.38 | $1,380.38 |
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 $1,174.90 Median $1,258.93 Typical High $1,995.26 | Professional | None | $1,174.90 | $1,258.93 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $1,174.90 Median $1,621.81 Typical High $2,818.38 | Professional | None | $1,174.90 | $1,621.81 | $2,818.38 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,778.28 Median $4,168.69 Typical High $6,918.31 | Facility | None | $1,778.28 | $4,168.69 | $6,918.31 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,445.44 Median $1,778.28 Typical High $2,041.74 | Professional | None | $1,445.44 | $1,778.28 | $2,041.74 |
Priority Health Setting Professional Modifier None Typical Low $1,148.15 Median $1,548.82 Typical High $2,630.27 | Professional | None | $1,148.15 | $1,548.82 | $2,630.27 |
United Setting Facility Modifier None Typical Low $851.14 Median $2,238.72 Typical High $6,918.31 | Facility | None | $851.14 | $2,238.72 | $6,918.31 |
United Setting Professional Modifier None Typical Low $1,584.89 Median $2,041.74 Typical High $2,187.76 | Professional | None | $1,584.89 | $2,041.74 | $2,187.76 |
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 $891.25 Median $912.01 Typical High $912.01 | Professional | 52 · Reduced service | $891.25 | $912.01 | $912.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $363.08 Median $363.08 Typical High $363.08 | Professional | 53 · Discontinued | $363.08 | $363.08 | $363.08 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,348.96 Median $1,380.38 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,348.96 | $1,380.38 | $1,380.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $275.42 Typical High $275.42 | Professional | 55 · Aftercare only | $269.15 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $181.97 Median $181.97 Typical High $181.97 | Professional | 56 · Pre-op care only | $181.97 | $181.97 | $181.97 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $1,288.25 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,258.93 | $1,288.25 | $1,288.25 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $891.25 Median $891.25 Typical High $891.25 | Professional | 52 · Reduced service | $891.25 | $891.25 | $891.25 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $354.81 Median $354.81 Typical High $354.81 | Professional | 53 · Discontinued | $354.81 | $354.81 | $354.81 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $1,348.96 Median $1,348.96 Typical High $1,348.96 | Professional | 54 · Surgery only | $1,348.96 | $1,348.96 | $1,348.96 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $269.15 Typical High $269.15 | Professional | 55 · Aftercare only | $269.15 | $269.15 | $269.15 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | 56 · Pre-op care only | $177.83 | $177.83 | $177.83 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $1,258.93 Typical High $1,258.93 | Professional | 78 · Unplanned return to OR | $1,258.93 | $1,258.93 | $1,258.93 |
Where Michigan sits
The same service costs 8.5 times more in Maine than in Delaware. 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 $28,081DE $3,299
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.