How much rates vary
Facilitymedian $2,188 · 10th to 90th $427 to $4,074Professionalmedian $380 · 10th to 90th $240 to $575
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 $478.63 Typical High $4,897.79 | Facility | None | $346.74 | $478.63 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $218.78 Median $338.84 Typical High $478.63 | Professional | None | $218.78 | $338.84 | $478.63 |
Ambetter Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | None | $239.88 | $239.88 | $239.88 |
BCBS Michigan Setting Facility Modifier None Typical Low $2,187.76 Median $2,187.76 Typical High $3,801.89 | Facility | None | $2,187.76 | $2,187.76 | $3,801.89 |
BCBS Michigan Setting Professional Modifier None Typical Low $64.57 Median $407.38 Typical High $630.96 | Professional | None | $64.57 | $407.38 | $630.96 |
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 $218.78 Median $363.08 Typical High $660.69 | Professional | None | $218.78 | $363.08 | $660.69 |
Health Alliance Plan Setting Facility Modifier None Typical Low $346.74 Median $954.99 Typical High $4,897.79 | Facility | None | $346.74 | $954.99 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $251.19 Median $380.19 Typical High $512.86 | Professional | None | $251.19 | $380.19 | $512.86 |
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 $190.55 Median $338.84 Typical High $562.34 | Professional | None | $190.55 | $338.84 | $562.34 |
United Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $3,162.28 | Facility | None | $426.58 | $602.56 | $3,162.28 |
United Setting Professional Modifier None Typical Low $288.40 Median $371.54 Typical High $489.78 | Professional | None | $288.40 | $371.54 | $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 $165.96 Median $173.78 Typical High $239.88 | Professional | 52 · Reduced service | $165.96 | $173.78 | $239.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $66.07 Median $69.18 Typical High $95.50 | Professional | 53 · Discontinued | $66.07 | $69.18 | $95.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $251.19 Median $257.04 Typical High $354.81 | Professional | 54 · Surgery only | $251.19 | $257.04 | $354.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $50.12 Median $51.29 Typical High $70.79 | Professional | 55 · Aftercare only | $50.12 | $51.29 | $70.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $33.11 Median $34.67 Typical High $47.86 | Professional | 56 · Pre-op care only | $33.11 | $34.67 | $47.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $234.42 Median $239.88 Typical High $331.13 | Professional | 78 · Unplanned return to OR | $234.42 | $239.88 | $331.13 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $616.60 Median $616.60 Typical High $954.99 | Professional | 50 · Both sides | $616.60 | $616.60 | $954.99 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $165.96 Median $169.82 Typical High $245.47 | Professional | 52 · Reduced service | $165.96 | $169.82 | $245.47 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $66.07 Median $69.18 Typical High $100.00 | Professional | 53 · Discontinued | $66.07 | $69.18 | $100.00 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $245.47 Median $257.04 Typical High $371.54 | Professional | 54 · Surgery only | $245.47 | $257.04 | $371.54 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $48.98 Median $51.29 Typical High $74.13 | Professional | 55 · Aftercare only | $48.98 | $51.29 | $74.13 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $33.11 Median $33.88 Typical High $48.98 | Professional | 56 · Pre-op care only | $33.11 | $33.88 | $48.98 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $229.09 Median $239.88 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $229.09 | $239.88 | $346.74 |
Where Michigan sits
The same service costs 4.9 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 $4,754MT $976
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.