How much rates vary
Facilitymedian $2,291 · 10th to 90th $794 to $4,898Professionalmedian $776 · 10th to 90th $575 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 $758.58 Median $794.33 Typical High $5,754.40 | Facility | None | $758.58 | $794.33 | $5,754.40 |
Aetna Setting Professional Modifier None Typical Low $602.56 Median $776.25 Typical High $831.76 | Professional | None | $602.56 | $776.25 | $831.76 |
Ambetter Setting Professional Modifier None Typical Low $501.19 Median $501.19 Typical High $501.19 | Professional | None | $501.19 | $501.19 | $501.19 |
BCBS Michigan Setting Facility Modifier None Typical Low $2,290.87 Median $2,290.87 Typical High $3,981.07 | Facility | None | $2,290.87 | $2,290.87 | $3,981.07 |
BCBS Michigan Setting Professional Modifier None Typical Low $478.63 Median $1,096.48 Typical High $1,548.82 | Professional | None | $478.63 | $1,096.48 | $1,548.82 |
Cigna Setting Facility Modifier None Typical Low $891.25 Median $891.25 Typical High $891.25 | Facility | None | $891.25 | $891.25 | $891.25 |
Cigna Setting Professional Modifier None Typical Low $446.68 Median $691.83 Typical High $1,445.44 | Professional | None | $446.68 | $691.83 | $1,445.44 |
Health Alliance Plan Setting Facility Modifier None Typical Low $776.25 Median $1,949.84 Typical High $7,943.28 | Facility | None | $776.25 | $1,949.84 | $7,943.28 |
Health Alliance Plan Setting Professional Modifier None Typical Low $602.56 Median $776.25 Typical High $851.14 | Professional | None | $602.56 | $776.25 | $851.14 |
Priority Health Setting Facility Modifier None Typical Low $891.25 Median $891.25 Typical High $891.25 | Facility | None | $891.25 | $891.25 | $891.25 |
Priority Health Setting Professional Modifier None Typical Low $446.68 Median $691.83 Typical High $1,047.13 | Professional | None | $446.68 | $691.83 | $1,047.13 |
United Setting Facility Modifier None Typical Low $660.69 Median $1,548.82 Typical High $6,456.54 | Facility | None | $660.69 | $1,548.82 | $6,456.54 |
United Setting Professional Modifier None Typical Low $602.56 Median $691.83 Typical High $776.25 | Professional | None | $602.56 | $691.83 | $776.25 |
13 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 $380.19 Median $389.05 Typical High $389.05 | Professional | 52 · Reduced service | $380.19 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $151.36 Median $154.88 Typical High $154.88 | Professional | 53 · Discontinued | $151.36 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $562.34 Median $588.84 Typical High $588.84 | Professional | 54 · Surgery only | $562.34 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $112.20 Median $117.49 Typical High $117.49 | Professional | 55 · Aftercare only | $112.20 | $117.49 | $117.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $77.62 Typical High $77.62 | Professional | 56 · Pre-op care only | $75.86 | $77.62 | $77.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $524.81 Median $549.54 Typical High $549.54 | Professional | 78 · Unplanned return to OR | $524.81 | $549.54 | $549.54 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $1,659.59 Median $1,659.59 Typical High $1,659.59 | Professional | 50 · Both sides | $1,659.59 | $1,659.59 | $1,659.59 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $380.19 Median $389.05 Typical High $389.05 | Professional | 52 · Reduced service | $380.19 | $389.05 | $389.05 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $151.36 Median $154.88 Typical High $154.88 | Professional | 53 · Discontinued | $151.36 | $154.88 | $154.88 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $562.34 Median $588.84 Typical High $588.84 | Professional | 54 · Surgery only | $562.34 | $588.84 | $588.84 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $112.20 Median $117.49 Typical High $117.49 | Professional | 55 · Aftercare only | $112.20 | $117.49 | $117.49 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $77.62 Typical High $77.62 | Professional | 56 · Pre-op care only | $75.86 | $77.62 | $77.62 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $524.81 Median $549.54 Typical High $549.54 | Professional | 78 · Unplanned return to OR | $524.81 | $549.54 | $549.54 |
Where Michigan sits
The same service costs 3.9 times more in Wisconsin than in Montana. 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
WI $7,471MT $1,932
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.