How much rates vary
Facilitymedian $1,047 · 10th to 90th $257 to $6,607Professionalmedian $813 · 10th to 90th $676 to $1,096
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 $724.44 Median $776.25 Typical High $6,918.31 | Facility | None | $724.44 | $776.25 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $630.96 Median $776.25 Typical High $933.25 | Professional | None | $630.96 | $776.25 | $933.25 |
Ambetter Setting Professional Modifier None Typical Low $588.84 Median $588.84 Typical High $588.84 | Professional | None | $588.84 | $588.84 | $588.84 |
BCBS Michigan Setting Facility Modifier None Typical Low $165.96 Median $380.19 Typical High $870.96 | Facility | None | $165.96 | $380.19 | $870.96 |
BCBS Michigan Setting Professional Modifier None Typical Low $870.96 Median $912.01 Typical High $977.24 | Professional | None | $870.96 | $912.01 | $977.24 |
Cigna Setting Professional Modifier None Typical Low $512.86 Median $912.01 Typical High $1,174.90 | Professional | None | $512.86 | $912.01 | $1,174.90 |
Health Alliance Plan Setting Facility Modifier None Typical Low $776.25 Median $2,089.30 Typical High $4,897.79 | Facility | None | $776.25 | $2,089.30 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $676.08 Median $776.25 Typical High $1,096.48 | Professional | None | $676.08 | $776.25 | $1,096.48 |
Priority Health Setting Professional Modifier None Typical Low $512.86 Median $912.01 Typical High $1,096.48 | Professional | None | $512.86 | $912.01 | $1,096.48 |
United Setting Facility Modifier None Typical Low $891.25 Median $2,691.53 Typical High $10,232.93 | Facility | None | $891.25 | $2,691.53 | $10,232.93 |
United Setting Professional Modifier None Typical Low $758.58 Median $912.01 Typical High $1,202.26 | Professional | None | $758.58 | $912.01 | $1,202.26 |
10 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 $323.59 Median $389.05 Typical High $389.05 | Professional | 52 · Reduced service | $323.59 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $128.82 Median $154.88 Typical High $154.88 | Professional | 53 · Discontinued | $128.82 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $478.63 Median $575.44 Typical High $588.84 | Professional | 54 · Surgery only | $478.63 | $575.44 | $588.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $114.82 Typical High $117.49 | Professional | 55 · Aftercare only | $95.50 | $114.82 | $117.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $64.57 Median $77.62 Typical High $77.62 | Professional | 56 · Pre-op care only | $64.57 | $77.62 | $77.62 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $331.13 Median $389.05 Typical High $389.05 | Professional | 52 · Reduced service | $331.13 | $389.05 | $389.05 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $131.83 Median $154.88 Typical High $154.88 | Professional | 53 · Discontinued | $131.83 | $154.88 | $154.88 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $489.78 Median $575.44 Typical High $575.44 | Professional | 54 · Surgery only | $489.78 | $575.44 | $575.44 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $100.00 Median $117.49 Typical High $117.49 | Professional | 55 · Aftercare only | $100.00 | $117.49 | $117.49 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $66.07 Median $77.62 Typical High $77.62 | Professional | 56 · Pre-op care only | $66.07 | $77.62 | $77.62 |
Where Michigan sits
The same service costs 28.7 times more in Maine than in Michigan. 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 $53,393MI $1,860
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.