How much rates vary
Facilitymedian $2,884 · 10th to 90th $912 to $5,370Professionalmedian $1,000 · 10th to 90th $708 to $1,175
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 $1,000.00 Median $1,071.52 Typical High $6,918.31 | Facility | None | $1,000.00 | $1,071.52 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $794.33 Median $1,023.29 Typical High $1,023.29 | Professional | None | $794.33 | $1,023.29 | $1,023.29 |
Ambetter Setting Professional Modifier None Typical Low $794.33 Median $794.33 Typical High $794.33 | Professional | None | $794.33 | $794.33 | $794.33 |
BCBS Michigan Setting Facility Modifier None Typical Low $2,884.03 Median $2,951.21 Typical High $5,011.87 | Facility | None | $2,884.03 | $2,951.21 | $5,011.87 |
BCBS Michigan Setting Professional Modifier None Typical Low $186.21 Median $1,071.52 Typical High $1,122.02 | Professional | None | $186.21 | $1,071.52 | $1,122.02 |
Cigna Setting Professional Modifier None Typical Low $645.65 Median $891.25 Typical High $1,584.89 | Professional | None | $645.65 | $891.25 | $1,584.89 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,000.00 Median $2,187.76 Typical High $4,897.79 | Facility | None | $1,000.00 | $2,187.76 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $794.33 Median $1,000.00 Typical High $1,122.02 | Professional | None | $794.33 | $1,000.00 | $1,122.02 |
Priority Health Setting Professional Modifier None Typical Low $630.96 Median $851.14 Typical High $1,445.44 | Professional | None | $630.96 | $851.14 | $1,445.44 |
United Setting Facility Modifier None Typical Low $660.69 Median $1,548.82 Typical High $6,025.60 | Facility | None | $660.69 | $1,548.82 | $6,025.60 |
United Setting Professional Modifier None Typical Low $891.25 Median $1,122.02 Typical High $1,230.27 | Professional | None | $891.25 | $1,122.02 | $1,230.27 |
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 $501.19 Median $512.86 Typical High $512.86 | Professional | 52 · Reduced service | $501.19 | $512.86 | $512.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $204.17 Typical High $204.17 | Professional | 53 · Discontinued | $199.53 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $758.58 Median $758.58 Typical High $758.58 | Professional | 54 · Surgery only | $758.58 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | 55 · Aftercare only | $151.36 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $102.33 Typical High $102.33 | Professional | 56 · Pre-op care only | $100.00 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $707.95 Median $707.95 Typical High $707.95 | Professional | 78 · Unplanned return to OR | $707.95 | $707.95 | $707.95 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $501.19 Median $501.19 Typical High $501.19 | Professional | 52 · Reduced service | $501.19 | $501.19 | $501.19 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $199.53 Typical High $199.53 | Professional | 53 · Discontinued | $199.53 | $199.53 | $199.53 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $741.31 Typical High $741.31 | Professional | 54 · Surgery only | $741.31 | $741.31 | $741.31 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $147.91 Typical High $147.91 | Professional | 55 · Aftercare only | $147.91 | $147.91 | $147.91 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $100.00 Typical High $100.00 | Professional | 56 · Pre-op care only | $100.00 | $100.00 | $100.00 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $691.83 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $691.83 | $691.83 | $691.83 |
Where Michigan sits
The same service costs 8.3 times more in Maine than in Texas. 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 $16,849TX $2,029
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.