How much rates vary
Facilitymedian $3,236 · 10th to 90th $501 to $5,248Professionalmedian $1,122 · 10th to 90th $776 to $1,288
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 $1,122.02 Median $1,122.02 Typical High $6,918.31 | Facility | None | $1,122.02 | $1,122.02 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $977.24 Median $1,122.02 Typical High $1,122.02 | Professional | None | $977.24 | $1,122.02 | $1,122.02 |
Ambetter Setting Professional Modifier None Typical Low $870.96 Median $870.96 Typical High $870.96 | Professional | None | $870.96 | $870.96 | $870.96 |
BCBS Setting Facility Modifier None Typical Low $3,235.94 Median $3,311.31 Typical High $5,623.41 | Facility | None | $3,235.94 | $3,311.31 | $5,623.41 |
BCBS Setting Professional Modifier None Typical Low $776.25 Median $1,230.27 Typical High $1,230.27 | Professional | None | $776.25 | $1,230.27 | $1,230.27 |
Cigna Setting Professional Modifier None Typical Low $707.95 Median $977.24 Typical High $1,778.28 | Professional | None | $707.95 | $977.24 | $1,778.28 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,122.02 Median $2,630.27 Typical High $4,897.79 | Facility | None | $1,122.02 | $2,630.27 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $891.25 Median $1,122.02 Typical High $1,258.93 | Professional | None | $891.25 | $1,122.02 | $1,258.93 |
Priority Health Setting Professional Modifier None Typical Low $707.95 Median $954.99 Typical High $1,659.59 | Professional | None | $707.95 | $954.99 | $1,659.59 |
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 $1,000.00 Median $1,230.27 Typical High $1,380.38 | Professional | None | $1,000.00 | $1,230.27 | $1,380.38 |
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 $562.34 Median $562.34 Typical High $562.34 | Professional | 52 · Reduced service | $562.34 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | 53 · Discontinued | $223.87 | $223.87 | $223.87 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $851.14 Typical High $851.14 | Professional | 54 · Surgery only | $831.76 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $169.82 Typical High $169.82 | Professional | 55 · Aftercare only | $165.96 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | 56 · Pre-op care only | $112.20 | $112.20 | $112.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $794.33 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $776.25 | $794.33 | $794.33 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $562.34 Median $562.34 Typical High $562.34 | Professional | 52 · Reduced service | $562.34 | $562.34 | $562.34 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | 53 · Discontinued | $223.87 | $223.87 | $223.87 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $831.76 Typical High $831.76 | Professional | 54 · Surgery only | $831.76 | $831.76 | $831.76 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $165.96 Typical High $165.96 | Professional | 55 · Aftercare only | $165.96 | $165.96 | $165.96 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | 56 · Pre-op care only | $112.20 | $112.20 | $112.20 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $776.25 Typical High $776.25 | Professional | 78 · Unplanned return to OR | $776.25 | $776.25 | $776.25 |
Where Michigan sits
The same service costs 11.7 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 $16,971MD $1,454
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.