How much rates vary
Facilitymedian $224 · 10th to 90th $120 to $1,072Professionalmedian $479 · 10th to 90th $141 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 $501.19 Median $2,041.74 Typical High $4,897.79 | Facility | None | $501.19 | $2,041.74 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $501.19 Median $524.81 Typical High $524.81 | Professional | None | $501.19 | $524.81 | $524.81 |
Ambetter Setting Professional Modifier None Typical Low $389.05 Median $389.05 Typical High $389.05 | Professional | None | $389.05 | $389.05 | $389.05 |
BCBS Michigan Setting Facility Modifier None Typical Low $199.53 Median $204.17 Typical High $354.81 | Facility | None | $199.53 | $204.17 | $354.81 |
BCBS Michigan Setting Professional Modifier None Typical Low $120.23 Median $741.31 Typical High $1,047.13 | Professional | None | $120.23 | $741.31 | $1,047.13 |
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 $302.00 Median $426.58 Typical High $616.60 | Professional | None | $302.00 | $426.58 | $616.60 |
Health Alliance Plan Setting Facility Modifier None Typical Low $85.11 Median $758.58 Typical High $2,041.74 | Facility | None | $85.11 | $758.58 | $2,041.74 |
Health Alliance Plan Setting Professional Modifier None Typical Low $371.54 Median $478.63 Typical High $524.81 | Professional | None | $371.54 | $478.63 | $524.81 |
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 $302.00 Median $407.38 Typical High $575.44 | Professional | None | $302.00 | $407.38 | $575.44 |
United Setting Facility Modifier None Typical Low $91.20 Median $177.83 Typical High $1,202.26 | Facility | None | $91.20 | $177.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $389.05 Median $416.87 Typical High $489.78 | Professional | None | $389.05 | $416.87 | $489.78 |
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 $251.19 Median $263.03 Typical High $263.03 | Professional | 52 · Reduced service | $251.19 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $104.71 Typical High $104.71 | Professional | 53 · Discontinued | $100.00 | $104.71 | $104.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $380.19 Median $389.05 Typical High $389.05 | Professional | 54 · Surgery only | $380.19 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $75.86 Median $77.62 Typical High $77.62 | Professional | 55 · Aftercare only | $75.86 | $77.62 | $77.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $50.12 Median $52.48 Typical High $52.48 | Professional | 56 · Pre-op care only | $50.12 | $52.48 | $52.48 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $354.81 Median $363.08 Typical High $363.08 | Professional | 78 · Unplanned return to OR | $354.81 | $363.08 | $363.08 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $1,122.02 Median $1,122.02 Typical High $1,122.02 | Professional | 50 · Both sides | $1,122.02 | $1,122.02 | $1,122.02 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $251.19 Median $257.04 Typical High $257.04 | Professional | 52 · Reduced service | $251.19 | $257.04 | $257.04 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $104.71 Typical High $104.71 | Professional | 53 · Discontinued | $100.00 | $104.71 | $104.71 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $371.54 Median $389.05 Typical High $389.05 | Professional | 54 · Surgery only | $371.54 | $389.05 | $389.05 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $75.86 Median $77.62 Typical High $77.62 | Professional | 55 · Aftercare only | $75.86 | $77.62 | $77.62 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $50.12 Median $52.48 Typical High $52.48 | Professional | 56 · Pre-op care only | $50.12 | $52.48 | $52.48 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $346.74 Median $363.08 Typical High $363.08 | Professional | 78 · Unplanned return to OR | $346.74 | $363.08 | $363.08 |
Where Michigan sits
The same service costs 6.4 times more in Connecticut than in Texas. 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
CT $3,322TX $515
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.