How much rates vary
Facilitymedian $3,890 · 10th to 90th $501 to $6,166Professionalmedian $1,349 · 10th to 90th $1,122 to $3,020
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 $1,288.25 Median $1,348.96 Typical High $6,918.31 | Facility | None | $1,288.25 | $1,348.96 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $1,047.13 Median $1,380.38 Typical High $1,380.38 | Professional | None | $1,047.13 | $1,380.38 | $1,380.38 |
BCBS Michigan Setting Facility Modifier None Typical Low $3,890.45 Median $3,981.07 Typical High $6,760.83 | Facility | None | $3,890.45 | $3,981.07 | $6,760.83 |
BCBS Michigan Setting Professional Modifier None Typical Low $831.76 Median $1,412.54 Typical High $3,019.95 | Professional | None | $831.76 | $1,412.54 | $3,019.95 |
Cigna Setting Professional Modifier None Typical Low $794.33 Median $1,230.27 Typical High $3,630.78 | Professional | None | $794.33 | $1,230.27 | $3,630.78 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,258.93 Median $3,235.94 Typical High $4,897.79 | Facility | None | $1,258.93 | $3,235.94 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $1,122.02 Median $1,318.26 Typical High $1,819.70 | Professional | None | $1,122.02 | $1,318.26 | $1,819.70 |
Priority Health Setting Professional Modifier None Typical Low $794.33 Median $1,348.96 Typical High $1,737.80 | Professional | None | $794.33 | $1,348.96 | $1,737.80 |
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 $1,122.02 Median $1,258.93 Typical High $1,698.24 | Professional | None | $1,122.02 | $1,258.93 | $1,698.24 |
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 $524.81 Median $691.83 Typical High $691.83 | Professional | 52 · Reduced service | $524.81 | $691.83 | $691.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $208.93 Median $275.42 Typical High $275.42 | Professional | 53 · Discontinued | $208.93 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $1,023.29 Typical High $1,023.29 | Professional | 54 · Surgery only | $794.33 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $204.17 Typical High $204.17 | Professional | 55 · Aftercare only | $158.49 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $104.71 Median $138.04 Typical High $138.04 | Professional | 56 · Pre-op care only | $104.71 | $138.04 | $138.04 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $954.99 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $741.31 | $954.99 | $954.99 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $630.96 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $630.96 | $660.69 | $660.69 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $251.19 | $263.03 | $263.03 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $954.99 Median $977.24 Typical High $977.24 | Professional | 54 · Surgery only | $954.99 | $977.24 | $977.24 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $190.55 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $190.55 | $199.53 | $199.53 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $125.89 | $131.83 | $131.83 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $891.25 Median $912.01 Typical High $912.01 | Professional | 78 · Unplanned return to OR | $891.25 | $912.01 | $912.01 |
Where Michigan sits
The same service costs 9.8 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 $16,204MD $1,659
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.