How much rates vary
Facilitymedian $4,677 · 10th to 90th $501 to $7,413Professionalmedian $1,660 · 10th to 90th $457 to $2,692
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 $1,202.26 Median $1,778.28 Typical High $1,778.28 | Professional | None | $1,202.26 | $1,778.28 | $1,778.28 |
BCBS Michigan Setting Facility Modifier None Typical Low $4,677.35 Median $4,786.30 Typical High $8,317.64 | Facility | None | $4,677.35 | $4,786.30 | $8,317.64 |
BCBS Michigan Setting Professional Modifier None Typical Low $338.84 Median $1,819.70 Typical High $2,691.53 | Professional | None | $338.84 | $1,819.70 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,023.29 Median $1,548.82 Typical High $4,570.88 | Professional | None | $1,023.29 | $1,548.82 | $4,570.88 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,621.81 Median $3,981.07 Typical High $4,897.79 | Facility | None | $1,621.81 | $3,981.07 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,348.96 Median $1,659.59 Typical High $2,238.72 | Professional | None | $1,348.96 | $1,659.59 | $2,238.72 |
Priority Health Setting Professional Modifier None Typical Low $1,023.29 Median $1,698.24 Typical High $2,187.76 | Professional | None | $1,023.29 | $1,698.24 | $2,187.76 |
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 $1,412.54 Median $1,548.82 Typical High $2,089.30 | Professional | None | $1,412.54 | $1,548.82 | $2,089.30 |
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 $645.65 Median $891.25 Typical High $891.25 | Professional | 52 · Reduced service | $645.65 | $891.25 | $891.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $354.81 Typical High $354.81 | Professional | 53 · Discontinued | $263.03 | $354.81 | $354.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $977.24 Median $1,318.26 Typical High $1,318.26 | Professional | 54 · Surgery only | $977.24 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $194.98 Median $263.03 Typical High $263.03 | Professional | 55 · Aftercare only | $194.98 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $177.83 Typical High $177.83 | Professional | 56 · Pre-op care only | $131.83 | $177.83 | $177.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $1,230.27 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $912.01 | $1,230.27 | $1,230.27 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $812.83 Median $831.76 Typical High $831.76 | Professional | 52 · Reduced service | $812.83 | $831.76 | $831.76 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $338.84 Typical High $338.84 | Professional | 53 · Discontinued | $323.59 | $338.84 | $338.84 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,258.93 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,202.26 | $1,258.93 | $1,258.93 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $251.19 Typical High $251.19 | Professional | 55 · Aftercare only | $239.88 | $251.19 | $251.19 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $165.96 Typical High $165.96 | Professional | 56 · Pre-op care only | $162.18 | $165.96 | $165.96 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,174.90 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,174.90 | $1,174.90 |
Where Michigan sits
The same service costs 8.5 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 $16,489MD $1,943
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.