How much rates vary
Facilitymedian $4,786 · 10th to 90th $490 to $7,586Professionalmedian $1,698 · 10th to 90th $1,096 to $2,630
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 $1,659.59 Median $1,698.24 Typical High $6,918.31 | Facility | None | $1,659.59 | $1,698.24 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $1,318.26 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,318.26 | $1,698.24 | $1,698.24 |
BCBS Michigan Setting Facility Modifier None Typical Low $4,786.30 Median $4,897.79 Typical High $8,317.64 | Facility | None | $4,786.30 | $4,897.79 | $8,317.64 |
BCBS Michigan Setting Professional Modifier None Typical Low $354.81 Median $1,905.46 Typical High $2,630.27 | Professional | None | $354.81 | $1,905.46 | $2,630.27 |
Cigna Setting Professional Modifier None Typical Low $954.99 Median $1,479.11 Typical High $3,981.07 | Professional | None | $954.99 | $1,479.11 | $3,981.07 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,621.81 Median $3,801.89 Typical High $4,897.79 | Facility | None | $1,621.81 | $3,801.89 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,288.25 Median $1,621.81 Typical High $1,995.26 | Professional | None | $1,288.25 | $1,621.81 | $1,995.26 |
Priority Health Setting Professional Modifier None Typical Low $954.99 Median $1,479.11 Typical High $1,819.70 | Professional | None | $954.99 | $1,479.11 | $1,819.70 |
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 $1,479.11 Median $1,737.80 Typical High $2,137.96 | Professional | None | $1,479.11 | $1,737.80 | $2,137.96 |
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 $724.44 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $724.44 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $338.84 Typical High $338.84 | Professional | 53 · Discontinued | $295.12 | $338.84 | $338.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,288.25 Typical High $1,288.25 | Professional | 54 · Surgery only | $1,096.48 | $1,288.25 | $1,288.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $218.78 Median $257.04 Typical High $257.04 | Professional | 55 · Aftercare only | $218.78 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $169.82 Typical High $169.82 | Professional | 56 · Pre-op care only | $147.91 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $1,202.26 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $1,023.29 | $1,202.26 | $1,202.26 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $2,818.38 Median $2,818.38 Typical High $2,818.38 | Professional | 50 · Both sides | $2,818.38 | $2,818.38 | $2,818.38 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $812.83 Median $812.83 Typical High $812.83 | Professional | 52 · Reduced service | $812.83 | $812.83 | $812.83 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $323.59 Typical High $323.59 | Professional | 53 · Discontinued | $323.59 | $323.59 | $323.59 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $1,230.27 Median $1,230.27 Typical High $1,230.27 | Professional | 54 · Surgery only | $1,230.27 | $1,230.27 | $1,230.27 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $245.47 Median $245.47 Typical High $245.47 | Professional | 55 · Aftercare only | $245.47 | $245.47 | $245.47 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | 56 · Pre-op care only | $162.18 | $162.18 | $162.18 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,148.15 Median $1,148.15 Typical High $1,148.15 | Professional | 78 · Unplanned return to OR | $1,148.15 | $1,148.15 | $1,148.15 |
Where Michigan sits
The same service costs 12.5 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 $24,646MD $1,975
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.