How much rates vary
Facilitymedian $1,549 · 10th to 90th $490 to $2,951Professionalmedian $550 · 10th to 90th $347 to $741
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 $426.58 Median $691.83 Typical High $4,897.79 | Facility | None | $426.58 | $691.83 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $426.58 Median $537.03 Typical High $724.44 | Professional | None | $426.58 | $537.03 | $724.44 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,548.82 Median $1,584.89 Typical High $2,754.23 | Facility | None | $1,548.82 | $1,584.89 | $2,754.23 |
BCBS Michigan Setting Professional Modifier None Typical Low $85.11 Median $524.81 Typical High $977.24 | Professional | None | $85.11 | $524.81 | $977.24 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $549.54 Typical High $549.54 | Facility | None | $549.54 | $549.54 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $457.09 Typical High $851.14 | Professional | None | $281.84 | $457.09 | $851.14 |
Health Alliance Plan Setting Facility Modifier None Typical Low $457.09 Median $707.95 Typical High $4,073.80 | Facility | None | $457.09 | $707.95 | $4,073.80 |
Health Alliance Plan Setting Professional Modifier None Typical Low $436.52 Median $645.65 Typical High $741.31 | Professional | None | $436.52 | $645.65 | $741.31 |
Priority Health Setting Facility Modifier None Typical Low $549.54 Median $549.54 Typical High $549.54 | Facility | None | $549.54 | $549.54 | $549.54 |
Priority Health Setting Professional Modifier None Typical Low $251.19 Median $457.09 Typical High $691.83 | Professional | None | $251.19 | $457.09 | $691.83 |
United Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $3,162.28 | Facility | None | $426.58 | $602.56 | $3,162.28 |
United Setting Professional Modifier None Typical Low $380.19 Median $489.78 Typical High $707.95 | Professional | None | $380.19 | $489.78 | $707.95 |
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 $213.80 Median $245.47 Typical High $346.74 | Professional | 52 · Reduced service | $213.80 | $245.47 | $346.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $85.11 Median $100.00 Typical High $138.04 | Professional | 53 · Discontinued | $85.11 | $100.00 | $138.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $323.59 Median $371.54 Typical High $524.81 | Professional | 54 · Surgery only | $323.59 | $371.54 | $524.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $64.57 Median $74.13 Typical High $104.71 | Professional | 55 · Aftercare only | $64.57 | $74.13 | $104.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $42.66 Median $50.12 Typical High $69.18 | Professional | 56 · Pre-op care only | $42.66 | $50.12 | $69.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $346.74 Typical High $489.78 | Professional | 78 · Unplanned return to OR | $302.00 | $346.74 | $489.78 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $213.80 Median $245.47 Typical High $354.81 | Professional | 52 · Reduced service | $213.80 | $245.47 | $354.81 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $85.11 Median $97.72 Typical High $144.54 | Professional | 53 · Discontinued | $85.11 | $97.72 | $144.54 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $316.23 Median $371.54 Typical High $537.03 | Professional | 54 · Surgery only | $316.23 | $371.54 | $537.03 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $63.10 Median $74.13 Typical High $107.15 | Professional | 55 · Aftercare only | $63.10 | $74.13 | $107.15 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $42.66 Median $48.98 Typical High $70.79 | Professional | 56 · Pre-op care only | $42.66 | $48.98 | $70.79 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $295.12 Median $346.74 Typical High $501.19 | Professional | 78 · Unplanned return to OR | $295.12 | $346.74 | $501.19 |
Where Michigan sits
The same service costs 4.4 times more in Colorado than in West Virginia. 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
CO $4,828WV $1,100
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.