How much rates vary
Facilitymedian $5,012 · 10th to 90th $501 to $7,762Professionalmedian $1,778 · 10th to 90th $1,380 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 $1,737.80 Median $1,778.28 Typical High $6,918.31 | Facility | None | $1,737.80 | $1,778.28 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $1,380.38 Median $1,778.28 Typical High $1,862.09 | Professional | None | $1,380.38 | $1,778.28 | $1,862.09 |
BCBS Michigan Setting Facility Modifier None Typical Low $5,011.87 Median $5,128.61 Typical High $8,709.64 | Facility | None | $5,011.87 | $5,128.61 | $8,709.64 |
BCBS Michigan Setting Professional Modifier None Typical Low $1,819.70 Median $1,949.84 Typical High $2,754.23 | Professional | None | $1,819.70 | $1,949.84 | $2,754.23 |
Cigna Setting Professional Modifier None Typical Low $977.24 Median $1,584.89 Typical High $4,168.69 | Professional | None | $977.24 | $1,584.89 | $4,168.69 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,698.24 Median $3,981.07 Typical High $4,897.79 | Facility | None | $1,698.24 | $3,981.07 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,380.38 Median $1,698.24 Typical High $2,137.96 | Professional | None | $1,380.38 | $1,698.24 | $2,137.96 |
Priority Health Setting Professional Modifier None Typical Low $977.24 Median $1,584.89 Typical High $1,905.46 | Professional | None | $977.24 | $1,584.89 | $1,905.46 |
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 $1,513.56 Median $1,819.70 Typical High $2,238.72 | Professional | None | $1,513.56 | $1,819.70 | $2,238.72 |
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 $758.58 Median $891.25 Typical High $891.25 | Professional | 52 · Reduced service | $758.58 | $891.25 | $891.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $354.81 Typical High $354.81 | Professional | 53 · Discontinued | $302.00 | $354.81 | $354.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $1,318.26 Typical High $1,318.26 | Professional | 54 · Surgery only | $1,148.15 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $263.03 Typical High $263.03 | Professional | 55 · Aftercare only | $229.09 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $177.83 Typical High $177.83 | Professional | 56 · Pre-op care only | $151.36 | $177.83 | $177.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,230.27 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,230.27 | $1,230.27 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $2,951.21 Median $2,951.21 Typical High $2,951.21 | Professional | 50 · Both sides | $2,951.21 | $2,951.21 | $2,951.21 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $851.14 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $851.14 | $851.14 | $851.14 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $338.84 Typical High $338.84 | Professional | 53 · Discontinued | $338.84 | $338.84 | $338.84 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $1,258.93 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,258.93 | $1,258.93 | $1,258.93 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $251.19 Typical High $251.19 | Professional | 55 · Aftercare only | $251.19 | $251.19 | $251.19 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $169.82 Typical High $169.82 | Professional | 56 · Pre-op care only | $169.82 | $169.82 | $169.82 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $1,174.90 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,174.90 | $1,174.90 | $1,174.90 |
Where Michigan sits
The same service costs 14.0 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 $28,122MD $2,008
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.