How much rates vary
Facilitymedian $1,950 · 10th to 90th $603 to $4,169Professionalmedian $479 · 10th to 90th $302 to $692
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 $398.11 Median $602.56 Typical High $4,897.79 | Facility | None | $398.11 | $602.56 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $269.15 Median $407.38 Typical High $602.56 | Professional | None | $269.15 | $407.38 | $602.56 |
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 $77.62 Median $489.78 Typical High $691.83 | Professional | None | $77.62 | $489.78 | $691.83 |
Cigna Setting Facility Modifier None Typical Low $630.96 Median $630.96 Typical High $630.96 | Facility | None | $630.96 | $630.96 | $630.96 |
Cigna Setting Professional Modifier None Typical Low $263.03 Median $457.09 Typical High $851.14 | Professional | None | $263.03 | $457.09 | $851.14 |
Health Alliance Plan Setting Facility Modifier None Typical Low $407.38 Median $1,348.96 Typical High $6,918.31 | Facility | None | $407.38 | $1,348.96 | $6,918.31 |
Health Alliance Plan Setting Professional Modifier None Typical Low $302.00 Median $478.63 Typical High $645.65 | Professional | None | $302.00 | $478.63 | $645.65 |
Priority Health Setting Facility Modifier None Typical Low $630.96 Median $630.96 Typical High $630.96 | Facility | None | $630.96 | $630.96 | $630.96 |
Priority Health Setting Professional Modifier None Typical Low $234.42 Median $407.38 Typical High $691.83 | Professional | None | $234.42 | $407.38 | $691.83 |
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 $346.74 Median $478.63 Typical High $602.56 | Professional | None | $346.74 | $478.63 | $602.56 |
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 $199.53 Median $218.78 Typical High $302.00 | Professional | 52 · Reduced service | $199.53 | $218.78 | $302.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $79.43 Median $87.10 Typical High $120.23 | Professional | 53 · Discontinued | $79.43 | $87.10 | $120.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $302.00 Median $323.59 Typical High $446.68 | Professional | 54 · Surgery only | $302.00 | $323.59 | $446.68 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $64.57 Typical High $91.20 | Professional | 55 · Aftercare only | $60.26 | $64.57 | $91.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $39.81 Median $43.65 Typical High $60.26 | Professional | 56 · Pre-op care only | $39.81 | $43.65 | $60.26 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $302.00 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $281.84 | $302.00 | $416.87 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $741.31 Median $741.31 Typical High $741.31 | Professional | 50 · Both sides | $741.31 | $741.31 | $741.31 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $199.53 Median $213.80 Typical High $309.03 | Professional | 52 · Reduced service | $199.53 | $213.80 | $309.03 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $79.43 Median $85.11 Typical High $123.03 | Professional | 53 · Discontinued | $79.43 | $85.11 | $123.03 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $295.12 Median $323.59 Typical High $467.74 | Professional | 54 · Surgery only | $295.12 | $323.59 | $467.74 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $64.57 Typical High $93.33 | Professional | 55 · Aftercare only | $60.26 | $64.57 | $93.33 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $39.81 Median $42.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $39.81 | $42.66 | $61.66 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $275.42 Median $302.00 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $275.42 | $302.00 | $436.52 |
Where Michigan sits
The same service costs 5.3 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 $6,378MT $1,193
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.