How much rates vary
Facilitymedian $1,230 · 10th to 90th $490 to $3,715Professionalmedian $309 · 10th to 90th $178 to $468
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 $234.42 Median $407.38 Typical High $4,897.79 | Facility | None | $234.42 | $407.38 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $165.96 Median $281.84 Typical High $407.38 | Professional | None | $165.96 | $281.84 | $407.38 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,202.26 Median $1,230.27 Typical High $2,137.96 | Facility | None | $1,202.26 | $1,230.27 | $2,137.96 |
BCBS Michigan Setting Professional Modifier None Typical Low $45.71 Median $288.40 Typical High $562.34 | Professional | None | $45.71 | $288.40 | $562.34 |
Cigna Setting Facility Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Facility | None | $407.38 | $407.38 | $407.38 |
Cigna Setting Professional Modifier None Typical Low $154.88 Median $302.00 Typical High $588.84 | Professional | None | $154.88 | $302.00 | $588.84 |
Health Alliance Plan Setting Facility Modifier None Typical Low $363.08 Median $1,258.93 Typical High $4,466.84 | Facility | None | $363.08 | $1,258.93 | $4,466.84 |
Health Alliance Plan Setting Professional Modifier None Typical Low $177.83 Median $338.84 Typical High $457.09 | Professional | None | $177.83 | $338.84 | $457.09 |
Priority Health Setting Facility Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Facility | None | $407.38 | $407.38 | $407.38 |
Priority Health Setting Professional Modifier None Typical Low $141.25 Median $257.04 Typical High $478.63 | Professional | None | $141.25 | $257.04 | $478.63 |
United Setting Facility Modifier None Typical Low $602.56 Median $1,230.27 Typical High $4,570.88 | Facility | None | $602.56 | $1,230.27 | $4,570.88 |
United Setting Professional Modifier None Typical Low $213.80 Median $309.03 Typical High $426.58 | Professional | None | $213.80 | $309.03 | $426.58 |
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 $117.49 Median $147.91 Typical High $204.17 | Professional | 52 · Reduced service | $117.49 | $147.91 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $58.88 Typical High $81.28 | Professional | 53 · Discontinued | $46.77 | $58.88 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $173.78 Median $223.87 Typical High $302.00 | Professional | 54 · Surgery only | $173.78 | $223.87 | $302.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $34.67 Median $44.67 Typical High $61.66 | Professional | 55 · Aftercare only | $34.67 | $44.67 | $61.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $29.51 Typical High $40.74 | Professional | 56 · Pre-op care only | $23.44 | $29.51 | $40.74 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $162.18 Median $208.93 Typical High $288.40 | Professional | 78 · Unplanned return to OR | $162.18 | $208.93 | $288.40 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $426.58 Median $831.76 Typical High $831.76 | Professional | 50 · Both sides | $426.58 | $831.76 | $831.76 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $117.49 Median $144.54 Typical High $213.80 | Professional | 52 · Reduced service | $117.49 | $144.54 | $213.80 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $58.88 Typical High $85.11 | Professional | 53 · Discontinued | $46.77 | $58.88 | $85.11 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $173.78 Median $218.78 Typical High $316.23 | Professional | 54 · Surgery only | $173.78 | $218.78 | $316.23 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $34.67 Median $43.65 Typical High $63.10 | Professional | 55 · Aftercare only | $34.67 | $43.65 | $63.10 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $28.84 Typical High $42.66 | Professional | 56 · Pre-op care only | $23.44 | $28.84 | $42.66 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $162.18 Median $204.17 Typical High $295.12 | Professional | 78 · Unplanned return to OR | $162.18 | $204.17 | $295.12 |
Where Michigan sits
The same service costs 6.4 times more in Oklahoma than in North Dakota. 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 $5,125ND $804
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.