How much rates vary
Facilitymedian $1,950 · 10th to 90th $589 to $4,169Professionalmedian $355 · 10th to 90th $245 to $589
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 $346.74 Median $371.54 Typical High $4,897.79 | Facility | None | $346.74 | $371.54 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $245.47 Median $269.15 Typical High $363.08 | Professional | None | $245.47 | $269.15 | $363.08 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $3,388.44 | Facility | None | $1,949.84 | $1,949.84 | $3,388.44 |
BCBS Michigan Setting Professional Modifier None Typical Low $234.42 Median $416.87 Typical High $588.84 | Professional | None | $234.42 | $416.87 | $588.84 |
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 $204.17 Median $346.74 Typical High $741.31 | Professional | None | $204.17 | $346.74 | $741.31 |
Health Alliance Plan Setting Facility Modifier None Typical Low $363.08 Median $1,258.93 Typical High $7,079.46 | Facility | None | $363.08 | $1,258.93 | $7,079.46 |
Health Alliance Plan Setting Professional Modifier None Typical Low $245.47 Median $346.74 Typical High $389.05 | Professional | None | $245.47 | $346.74 | $389.05 |
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 $204.17 Median $331.13 Typical High $602.56 | Professional | None | $204.17 | $331.13 | $602.56 |
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 $302.00 Median $354.81 Typical High $398.11 | Professional | None | $302.00 | $354.81 | $398.11 |
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 $173.78 Median $177.83 Typical High $177.83 | Professional | 52 · Reduced service | $173.78 | $177.83 | $177.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $70.79 Typical High $70.79 | Professional | 53 · Discontinued | $69.18 | $70.79 | $70.79 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $263.03 Median $269.15 Typical High $269.15 | Professional | 54 · Surgery only | $263.03 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $52.48 Median $53.70 Typical High $53.70 | Professional | 55 · Aftercare only | $52.48 | $53.70 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $35.48 Typical High $35.48 | Professional | 56 · Pre-op care only | $34.67 | $35.48 | $35.48 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $245.47 Median $251.19 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $245.47 | $251.19 | $251.19 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $630.96 Median $630.96 Typical High $630.96 | Professional | 50 · Both sides | $630.96 | $630.96 | $630.96 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $173.78 Median $181.97 Typical High $181.97 | Professional | 52 · Reduced service | $173.78 | $181.97 | $181.97 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $72.44 Typical High $72.44 | Professional | 53 · Discontinued | $69.18 | $72.44 | $72.44 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $257.04 Median $269.15 Typical High $269.15 | Professional | 54 · Surgery only | $257.04 | $269.15 | $269.15 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $52.48 Median $53.70 Typical High $53.70 | Professional | 55 · Aftercare only | $52.48 | $53.70 | $53.70 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $36.31 Typical High $36.31 | Professional | 56 · Pre-op care only | $34.67 | $36.31 | $36.31 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $239.88 Median $251.19 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $239.88 | $251.19 | $251.19 |
Where Michigan sits
The same service costs 7.3 times more in Colorado 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
CO $6,269MT $863
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.