How much rates vary
Facilitymedian $10,000 · 10th to 90th $501 to $15,488Professionalmedian $3,467 · 10th to 90th $2,344 to $6,166
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 $3,467.37 Median $3,630.78 Typical High $6,918.31 | Facility | None | $3,467.37 | $3,630.78 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $2,630.27 Median $3,715.35 Typical High $3,715.35 | Professional | None | $2,630.27 | $3,715.35 | $3,715.35 |
BCBS Michigan Setting Facility Modifier None Typical Low $10,000.00 Median $10,000.00 Typical High $17,378.01 | Facility | None | $10,000.00 | $10,000.00 | $17,378.01 |
BCBS Michigan Setting Professional Modifier None Typical Low $630.96 Median $3,715.35 Typical High $8,317.64 | Professional | None | $630.96 | $3,715.35 | $8,317.64 |
Cigna Setting Professional Modifier None Typical Low $2,137.96 Median $3,235.94 Typical High $9,549.93 | Professional | None | $2,137.96 | $3,235.94 | $9,549.93 |
Health Alliance Plan Setting Facility Modifier None Typical Low $3,388.44 Median $7,585.78 Typical High $8,511.38 | Facility | None | $3,388.44 | $7,585.78 | $8,511.38 |
Health Alliance Plan Setting Professional Modifier None Typical Low $2,884.03 Median $3,467.37 Typical High $4,677.35 | Professional | None | $2,884.03 | $3,467.37 | $4,677.35 |
Priority Health Setting Professional Modifier None Typical Low $2,137.96 Median $3,548.13 Typical High $4,570.88 | Professional | None | $2,137.96 | $3,548.13 | $4,570.88 |
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 $3,019.95 Median $3,235.94 Typical High $4,365.16 | Professional | None | $3,019.95 | $3,235.94 | $4,365.16 |
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 $1,412.54 Median $1,862.09 Typical High $1,862.09 | Professional | 52 · Reduced service | $1,412.54 | $1,862.09 | $1,862.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $562.34 Median $741.31 Typical High $741.31 | Professional | 53 · Discontinued | $562.34 | $741.31 | $741.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,089.30 Median $2,818.38 Typical High $2,818.38 | Professional | 54 · Surgery only | $2,089.30 | $2,818.38 | $2,818.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $416.87 Median $562.34 Typical High $562.34 | Professional | 55 · Aftercare only | $416.87 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $281.84 Median $371.54 Typical High $371.54 | Professional | 56 · Pre-op care only | $281.84 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,949.84 Median $2,630.27 Typical High $2,630.27 | Professional | 78 · Unplanned return to OR | $1,949.84 | $2,630.27 | $2,630.27 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $1,698.24 Median $1,737.80 Typical High $1,737.80 | Professional | 52 · Reduced service | $1,698.24 | $1,737.80 | $1,737.80 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $676.08 Median $691.83 Typical High $691.83 | Professional | 53 · Discontinued | $676.08 | $691.83 | $691.83 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $2,511.89 Median $2,630.27 Typical High $2,630.27 | Professional | 54 · Surgery only | $2,511.89 | $2,630.27 | $2,630.27 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $501.19 Median $524.81 Typical High $524.81 | Professional | 55 · Aftercare only | $501.19 | $524.81 | $524.81 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $338.84 Median $346.74 Typical High $346.74 | Professional | 56 · Pre-op care only | $338.84 | $346.74 | $346.74 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,344.23 Median $2,454.71 Typical High $2,454.71 | Professional | 78 · Unplanned return to OR | $2,344.23 | $2,454.71 | $2,454.71 |
Where Michigan sits
The same service costs 12.3 times more in Maine than in Washington. 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 $35,907WA $2,929
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.