How much rates vary
Facilitymedian $4,266 · 10th to 90th $631 to $6,918Professionalmedian $617 · 10th to 90th $417 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 $602.56 Median $630.96 Typical High $4,897.79 | Facility | None | $602.56 | $630.96 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $416.87 Median $549.54 Typical High $645.65 | Professional | None | $416.87 | $549.54 | $645.65 |
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 $4,265.80 Median $4,265.80 Typical High $7,413.10 | Facility | None | $4,265.80 | $4,265.80 | $7,413.10 |
BCBS Michigan Setting Professional Modifier None Typical Low $426.58 Median $691.83 Typical High $977.24 | Professional | None | $426.58 | $691.83 | $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 $354.81 Median $588.84 Typical High $1,621.81 | Professional | None | $354.81 | $588.84 | $1,621.81 |
Health Alliance Plan Setting Facility Modifier None Typical Low $602.56 Median $1,258.93 Typical High $4,897.79 | Facility | None | $602.56 | $1,258.93 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $416.87 Median $602.56 Typical High $660.69 | Professional | None | $416.87 | $602.56 | $660.69 |
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 $354.81 Median $562.34 Typical High $954.99 | Professional | None | $354.81 | $562.34 | $954.99 |
United Setting Facility Modifier None Typical Low $602.56 Median $1,230.27 Typical High $6,456.54 | Facility | None | $602.56 | $1,230.27 | $6,456.54 |
United Setting Professional Modifier None Typical Low $512.86 Median $602.56 Typical High $660.69 | Professional | None | $512.86 | $602.56 | $660.69 |
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 $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $302.00 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $120.23 Median $123.03 Typical High $123.03 | Professional | 53 · Discontinued | $120.23 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $457.09 Median $467.74 Typical High $467.74 | Professional | 54 · Surgery only | $457.09 | $467.74 | $467.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $91.20 Median $93.33 Typical High $93.33 | Professional | 55 · Aftercare only | $91.20 | $93.33 | $93.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $60.26 Median $61.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $60.26 | $61.66 | $61.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $426.58 Median $436.52 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $426.58 | $436.52 | $436.52 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $302.00 Median $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $302.00 | $309.03 | $309.03 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $120.23 Median $125.89 Typical High $125.89 | Professional | 53 · Discontinued | $120.23 | $125.89 | $125.89 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $446.68 Median $467.74 Typical High $467.74 | Professional | 54 · Surgery only | $446.68 | $467.74 | $467.74 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $89.13 Median $93.33 Typical High $93.33 | Professional | 55 · Aftercare only | $89.13 | $93.33 | $93.33 |
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 $416.87 Median $436.52 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $416.87 | $436.52 | $436.52 |
Where Michigan sits
The same service costs 7.0 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 $10,808MT $1,535
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.