How much rates vary
Facilitymedian $3,020 · 10th to 90th $646 to $6,310Professionalmedian $631 · 10th to 90th $479 to $1,047
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 $616.60 Median $660.69 Typical High $6,918.31 | Facility | None | $616.60 | $660.69 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $501.19 Median $630.96 Typical High $660.69 | Professional | None | $501.19 | $630.96 | $660.69 |
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 $3,019.95 Median $3,019.95 Typical High $5,248.07 | Facility | None | $3,019.95 | $3,019.95 | $5,248.07 |
BCBS Michigan Setting Professional Modifier None Typical Low $676.08 Median $758.58 Typical High $1,047.13 | Professional | None | $676.08 | $758.58 | $1,047.13 |
Cigna Setting Facility Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,230.27 | Facility | None | $1,230.27 | $1,230.27 | $1,230.27 |
Cigna Setting Professional Modifier None Typical Low $363.08 Median $562.34 Typical High $851.14 | Professional | None | $363.08 | $562.34 | $851.14 |
Health Alliance Plan Setting Facility Modifier None Typical Low $630.96 Median $1,584.89 Typical High $7,079.46 | Facility | None | $630.96 | $1,584.89 | $7,079.46 |
Health Alliance Plan Setting Professional Modifier None Typical Low $478.63 Median $616.60 Typical High $676.08 | Professional | None | $478.63 | $616.60 | $676.08 |
Priority Health Setting Facility Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,230.27 | Facility | None | $1,230.27 | $1,230.27 | $1,230.27 |
Priority Health Setting Professional Modifier None Typical Low $363.08 Median $549.54 Typical High $851.14 | Professional | None | $363.08 | $549.54 | $851.14 |
United Setting Facility Modifier None Typical Low $602.56 Median $1,230.27 Typical High $5,248.07 | Facility | None | $602.56 | $1,230.27 | $5,248.07 |
United Setting Professional Modifier None Typical Low $489.78 Median $549.54 Typical High $616.60 | Professional | None | $489.78 | $549.54 | $616.60 |
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 $302.00 Median $316.23 Typical High $316.23 | Professional | 52 · Reduced service | $302.00 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $123.03 Median $125.89 Typical High $125.89 | Professional | 53 · Discontinued | $123.03 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $457.09 Median $478.63 Typical High $478.63 | Professional | 54 · Surgery only | $457.09 | $478.63 | $478.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $91.20 Median $95.50 Typical High $95.50 | Professional | 55 · Aftercare only | $91.20 | $95.50 | $95.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $61.66 Median $63.10 Typical High $63.10 | Professional | 56 · Pre-op care only | $61.66 | $63.10 | $63.10 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $426.58 Median $446.68 Typical High $446.68 | Professional | 78 · Unplanned return to OR | $426.58 | $446.68 | $446.68 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $302.00 Median $316.23 Typical High $316.23 | Professional | 52 · Reduced service | $302.00 | $316.23 | $316.23 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $123.03 Median $125.89 Typical High $125.89 | Professional | 53 · Discontinued | $123.03 | $125.89 | $125.89 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $457.09 Median $478.63 Typical High $478.63 | Professional | 54 · Surgery only | $457.09 | $478.63 | $478.63 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $91.20 Median $95.50 Typical High $95.50 | Professional | 55 · Aftercare only | $91.20 | $95.50 | $95.50 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $60.26 Median $63.10 Typical High $63.10 | Professional | 56 · Pre-op care only | $60.26 | $63.10 | $63.10 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $426.58 Median $446.68 Typical High $446.68 | Professional | 78 · Unplanned return to OR | $426.58 | $446.68 | $446.68 |
Where Michigan sits
The same service costs 5.4 times more in Alabama 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
AL $8,312MT $1,553
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.