How much rates vary
Facilitymedian $1,950 · 10th to 90th $631 to $4,074Professionalmedian $468 · 10th to 90th $324 to $562
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 $323.59 Median $489.78 Typical High $4,897.79 | Facility | None | $323.59 | $489.78 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $323.59 Median $371.54 Typical High $478.63 | Professional | None | $323.59 | $371.54 | $478.63 |
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 $537.03 Typical High $562.34 | Professional | None | $234.42 | $537.03 | $562.34 |
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 $213.80 Median $371.54 Typical High $776.25 | Professional | None | $213.80 | $371.54 | $776.25 |
Health Alliance Plan Setting Facility Modifier None Typical Low $478.63 Median $1,258.93 Typical High $4,897.79 | Facility | None | $478.63 | $1,258.93 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $331.13 Median $501.19 Typical High $588.84 | Professional | None | $331.13 | $501.19 | $588.84 |
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 $194.98 Median $354.81 Typical High $630.96 | Professional | None | $194.98 | $354.81 | $630.96 |
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 $309.03 Median $416.87 Typical High $562.34 | Professional | None | $309.03 | $416.87 | $562.34 |
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 $162.18 Median $181.97 Typical High $239.88 | Professional | 52 · Reduced service | $162.18 | $181.97 | $239.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $64.57 Median $74.13 Typical High $95.50 | Professional | 53 · Discontinued | $64.57 | $74.13 | $95.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $245.47 Median $275.42 Typical High $363.08 | Professional | 54 · Surgery only | $245.47 | $275.42 | $363.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $48.98 Median $54.95 Typical High $72.44 | Professional | 55 · Aftercare only | $48.98 | $54.95 | $72.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $32.36 Median $37.15 Typical High $47.86 | Professional | 56 · Pre-op care only | $32.36 | $37.15 | $47.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $229.09 Median $257.04 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $229.09 | $257.04 | $338.84 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $602.56 Median $602.56 Typical High $602.56 | Professional | 50 · Both sides | $602.56 | $602.56 | $602.56 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $162.18 Median $173.78 Typical High $251.19 | Professional | 52 · Reduced service | $162.18 | $173.78 | $251.19 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $64.57 Median $69.18 Typical High $100.00 | Professional | 53 · Discontinued | $64.57 | $69.18 | $100.00 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $239.88 Median $263.03 Typical High $371.54 | Professional | 54 · Surgery only | $239.88 | $263.03 | $371.54 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $47.86 Median $52.48 Typical High $74.13 | Professional | 55 · Aftercare only | $47.86 | $52.48 | $74.13 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $32.36 Median $34.67 Typical High $50.12 | Professional | 56 · Pre-op care only | $32.36 | $34.67 | $50.12 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $223.87 Median $245.47 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $223.87 | $245.47 | $346.74 |
Where Michigan sits
The same service costs 6.1 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 $6,296MT $1,039
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.