How much rates vary
Facilitymedian $4,169 · 10th to 90th $501 to $6,607Professionalmedian $1,445 · 10th to 90th $1,047 to $1,660
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 $1,096.48 Median $1,445.44 Typical High $6,918.31 | Facility | None | $1,096.48 | $1,445.44 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $1,096.48 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,096.48 | $1,479.11 | $1,479.11 |
BCBS Michigan Setting Facility Modifier None Typical Low $4,168.69 Median $4,265.80 Typical High $7,413.10 | Facility | None | $4,168.69 | $4,265.80 | $7,413.10 |
BCBS Michigan Setting Professional Modifier None Typical Low $331.13 Median $1,047.13 Typical High $1,659.59 | Professional | None | $331.13 | $1,047.13 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $870.96 Median $1,412.54 Typical High $3,235.94 | Professional | None | $870.96 | $1,412.54 | $3,235.94 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,445.44 Median $3,548.13 Typical High $4,897.79 | Facility | None | $1,445.44 | $3,548.13 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,230.27 Median $1,445.44 Typical High $1,737.80 | Professional | None | $1,230.27 | $1,445.44 | $1,737.80 |
Priority Health Setting Professional Modifier None Typical Low $870.96 Median $1,412.54 Typical High $1,995.26 | Professional | None | $870.96 | $1,412.54 | $1,995.26 |
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 $1,288.25 Median $1,412.54 Typical High $1,862.09 | Professional | None | $1,288.25 | $1,412.54 | $1,862.09 |
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 $537.03 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $537.03 | $724.44 | $724.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $218.78 Median $295.12 Typical High $295.12 | Professional | 53 · Discontinued | $218.78 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $1,096.48 Typical High $1,096.48 | Professional | 54 · Surgery only | $812.83 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $162.18 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $162.18 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $147.91 Typical High $147.91 | Professional | 56 · Pre-op care only | $109.65 | $147.91 | $147.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $1,023.29 Typical High $1,023.29 | Professional | 78 · Unplanned return to OR | $758.58 | $1,023.29 | $1,023.29 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $724.44 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $724.44 | $724.44 | $724.44 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $288.40 Median $288.40 Typical High $288.40 | Professional | 53 · Discontinued | $288.40 | $288.40 | $288.40 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,071.52 Typical High $1,071.52 | Professional | 54 · Surgery only | $1,071.52 | $1,071.52 | $1,071.52 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $218.78 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $218.78 | $218.78 | $218.78 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $144.54 Median $144.54 Typical High $144.54 | Professional | 56 · Pre-op care only | $144.54 | $144.54 | $144.54 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,000.00 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,000.00 | $1,000.00 |
Where Michigan sits
The same service costs 15.4 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 $28,500MD $1,851
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.