How much rates vary
Facilitymedian $4,266 · 10th to 90th $891 to $8,318Professionalmedian $759 · 10th to 90th $525 to $1,202
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 $741.31 Median $812.83 Typical High $4,897.79 | Facility | None | $741.31 | $812.83 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $588.84 Median $776.25 Typical High $812.83 | Professional | None | $588.84 | $776.25 | $812.83 |
Ambetter Setting Professional Modifier None Typical Low $524.81 Median $1,071.52 Typical High $1,071.52 | Professional | None | $524.81 | $1,071.52 | $1,071.52 |
BCBS Michigan Setting Facility Modifier None Typical Low $4,265.80 Median $4,365.16 Typical High $7,413.10 | Facility | None | $4,265.80 | $4,365.16 | $7,413.10 |
BCBS Michigan Setting Professional Modifier None Typical Low $169.82 Median $851.14 Typical High $1,258.93 | Professional | None | $169.82 | $851.14 | $1,258.93 |
Cigna Setting Facility Modifier None Typical Low $776.25 Median $776.25 Typical High $776.25 | Facility | None | $776.25 | $776.25 | $776.25 |
Cigna Setting Professional Modifier None Typical Low $436.52 Median $676.08 Typical High $1,445.44 | Professional | None | $436.52 | $676.08 | $1,445.44 |
Health Alliance Plan Setting Facility Modifier None Typical Low $776.25 Median $2,884.03 Typical High $9,120.11 | Facility | None | $776.25 | $2,884.03 | $9,120.11 |
Health Alliance Plan Setting Professional Modifier None Typical Low $575.44 Median $758.58 Typical High $812.83 | Professional | None | $575.44 | $758.58 | $812.83 |
Priority Health Setting Facility Modifier None Typical Low $776.25 Median $776.25 Typical High $776.25 | Facility | None | $776.25 | $776.25 | $776.25 |
Priority Health Setting Professional Modifier None Typical Low $436.52 Median $602.56 Typical High $1,023.29 | Professional | None | $436.52 | $602.56 | $1,023.29 |
United Setting Facility Modifier None Typical Low $891.25 Median $2,818.38 Typical High $9,120.11 | Facility | None | $891.25 | $2,818.38 | $9,120.11 |
United Setting Professional Modifier None Typical Low $588.84 Median $645.65 Typical High $741.31 | Professional | None | $588.84 | $645.65 | $741.31 |
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 $371.54 Median $380.19 Typical High $380.19 | Professional | 52 · Reduced service | $371.54 | $380.19 | $380.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $154.88 Typical High $154.88 | Professional | 53 · Discontinued | $147.91 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $575.44 Typical High $575.44 | Professional | 54 · Surgery only | $549.54 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $112.20 Median $114.82 Typical High $114.82 | Professional | 55 · Aftercare only | $112.20 | $114.82 | $114.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $74.13 Median $77.62 Typical High $77.62 | Professional | 56 · Pre-op care only | $74.13 | $77.62 | $77.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $537.03 Typical High $537.03 | Professional | 78 · Unplanned return to OR | $512.86 | $537.03 | $537.03 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $371.54 Median $380.19 Typical High $380.19 | Professional | 52 · Reduced service | $371.54 | $380.19 | $380.19 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $151.36 Typical High $151.36 | Professional | 53 · Discontinued | $147.91 | $151.36 | $151.36 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $575.44 Typical High $575.44 | Professional | 54 · Surgery only | $549.54 | $575.44 | $575.44 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $114.82 Typical High $114.82 | Professional | 55 · Aftercare only | $109.65 | $114.82 | $114.82 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $74.13 Median $75.86 Typical High $75.86 | Professional | 56 · Pre-op care only | $74.13 | $75.86 | $75.86 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $537.03 Typical High $537.03 | Professional | 78 · Unplanned return to OR | $512.86 | $537.03 | $537.03 |
Where Michigan sits
The same service costs 4.7 times more in Oklahoma 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
OK $8,820MT $1,888
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.