How much rates vary
Facilitymedian $5,888 · 10th to 90th $2,692 to $15,136Professionalmedian $1,202 · 10th to 90th $457 to $9,333
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 $645.65 Median $5,754.40 Typical High $6,606.93 | Facility | None | $645.65 | $5,754.40 | $6,606.93 |
Aetna Setting Professional Modifier None Typical Low $645.65 Median $5,370.32 Typical High $6,606.93 | Professional | None | $645.65 | $5,370.32 | $6,606.93 |
Ambetter Setting Professional Modifier None Typical Low $436.52 Median $436.52 Typical High $436.52 | Professional | None | $436.52 | $436.52 | $436.52 |
BCBS Michigan Setting Facility Modifier None Typical Low $5,248.07 Median $5,888.44 Typical High $15,135.61 | Facility | None | $5,248.07 | $5,888.44 | $15,135.61 |
BCBS Michigan Setting Professional Modifier None Typical Low $120.23 Median $707.95 Typical High $9,549.93 | Professional | None | $120.23 | $707.95 | $9,549.93 |
Cigna Setting Professional Modifier None Typical Low $426.58 Median $3,162.28 Typical High $9,772.37 | Professional | None | $426.58 | $3,162.28 | $9,772.37 |
Health Alliance Plan Setting Facility Modifier None Typical Low $3,715.35 Median $5,888.44 Typical High $19,952.62 | Facility | None | $3,715.35 | $5,888.44 | $19,952.62 |
Health Alliance Plan Setting Professional Modifier None Typical Low $676.08 Median $7,244.36 Typical High $9,120.11 | Professional | None | $676.08 | $7,244.36 | $9,120.11 |
Priority Health Setting Professional Modifier None Typical Low $416.87 Median $3,162.28 Typical High $9,332.54 | Professional | None | $416.87 | $3,162.28 | $9,332.54 |
United Setting Facility Modifier None Typical Low $891.25 Median $2,818.38 Typical High $10,471.29 | Facility | None | $891.25 | $2,818.38 | $10,471.29 |
United Setting Professional Modifier None Typical Low $630.96 Median $5,011.87 Typical High $9,549.93 | Professional | None | $630.96 | $5,011.87 | $9,549.93 |
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 $323.59 Median $2,570.40 Typical High $3,311.31 | Professional | 52 · Reduced service | $323.59 | $2,570.40 | $3,311.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $128.82 Median $1,023.29 Typical High $1,318.26 | Professional | 53 · Discontinued | $128.82 | $1,023.29 | $1,318.26 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $489.78 Median $3,890.45 Typical High $4,897.79 | Professional | 54 · Surgery only | $489.78 | $3,890.45 | $4,897.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $97.72 Median $776.25 Typical High $977.24 | Professional | 55 · Aftercare only | $97.72 | $776.25 | $977.24 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $64.57 Median $512.86 Typical High $660.69 | Professional | 56 · Pre-op care only | $64.57 | $512.86 | $660.69 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $457.09 Median $3,630.78 Typical High $4,570.88 | Professional | 78 · Unplanned return to OR | $457.09 | $3,630.78 | $4,570.88 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $323.59 Median $524.81 Typical High $3,630.78 | Professional | 52 · Reduced service | $323.59 | $524.81 | $3,630.78 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $131.83 Median $208.93 Typical High $1,445.44 | Professional | 53 · Discontinued | $131.83 | $208.93 | $1,445.44 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $489.78 Median $776.25 Typical High $5,495.41 | Professional | 54 · Surgery only | $489.78 | $776.25 | $5,495.41 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $97.72 Median $154.88 Typical High $1,096.48 | Professional | 55 · Aftercare only | $97.72 | $154.88 | $1,096.48 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $66.07 Median $104.71 Typical High $724.44 | Professional | 56 · Pre-op care only | $66.07 | $104.71 | $724.44 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $457.09 Median $724.44 Typical High $5,128.61 | Professional | 78 · Unplanned return to OR | $457.09 | $724.44 | $5,128.61 |
Where Michigan sits
The same service costs 5.8 times more in Oklahoma than in Mississippi. 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
OK $20,151MS $3,493
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.