How much rates vary
Facilitymedian $5,754 · 10th to 90th $501 to $8,913Professionalmedian $2,089 · 10th to 90th $1,445 to $3,311
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 $2,041.74 Median $2,089.30 Typical High $6,918.31 | Facility | None | $2,041.74 | $2,089.30 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $1,513.56 Median $2,187.76 Typical High $2,187.76 | Professional | None | $1,513.56 | $2,187.76 | $2,187.76 |
BCBS Michigan Setting Facility Modifier None Typical Low $5,754.40 Median $5,888.44 Typical High $10,000.00 | Facility | None | $5,754.40 | $5,888.44 | $10,000.00 |
BCBS Michigan Setting Professional Modifier None Typical Low $562.34 Median $2,238.72 Typical High $5,011.87 | Professional | None | $562.34 | $2,238.72 | $5,011.87 |
Cigna Setting Professional Modifier None Typical Low $1,258.93 Median $1,905.46 Typical High $5,623.41 | Professional | None | $1,258.93 | $1,905.46 | $5,623.41 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,995.26 Median $4,786.30 Typical High $4,897.79 | Facility | None | $1,995.26 | $4,786.30 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,659.59 Median $2,089.30 Typical High $2,691.53 | Professional | None | $1,659.59 | $2,089.30 | $2,691.53 |
Priority Health Setting Professional Modifier None Typical Low $1,258.93 Median $2,041.74 Typical High $2,691.53 | Professional | None | $1,258.93 | $2,041.74 | $2,691.53 |
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 $1,737.80 Median $1,905.46 Typical High $2,570.40 | Professional | None | $1,737.80 | $1,905.46 | $2,570.40 |
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 $794.33 Median $1,096.48 Typical High $1,096.48 | Professional | 52 · Reduced service | $794.33 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $436.52 Typical High $436.52 | Professional | 53 · Discontinued | $316.23 | $436.52 | $436.52 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,621.81 Typical High $1,621.81 | Professional | 54 · Surgery only | $1,202.26 | $1,621.81 | $1,621.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $323.59 Typical High $323.59 | Professional | 55 · Aftercare only | $239.88 | $323.59 | $323.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $218.78 Typical High $218.78 | Professional | 56 · Pre-op care only | $158.49 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,513.56 Typical High $1,513.56 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,513.56 | $1,513.56 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $1,000.00 Median $1,023.29 Typical High $1,023.29 | Professional | 52 · Reduced service | $1,000.00 | $1,023.29 | $1,023.29 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $398.11 Median $416.87 Typical High $416.87 | Professional | 53 · Discontinued | $398.11 | $416.87 | $416.87 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $1,479.11 Median $1,548.82 Typical High $1,548.82 | Professional | 54 · Surgery only | $1,479.11 | $1,548.82 | $1,548.82 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $302.00 Median $309.03 Typical High $309.03 | Professional | 55 · Aftercare only | $302.00 | $309.03 | $309.03 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $199.53 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $199.53 | $208.93 | $208.93 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,380.38 Median $1,445.44 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $1,380.38 | $1,445.44 | $1,445.44 |
Where Michigan sits
The same service costs 15.5 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 $34,449MD $2,222
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.