How much rates vary
Facilitymedian $724 · 10th to 90th $135 to $1,413Professionalmedian $501 · 10th to 90th $380 to $832
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 $524.81 Median $602.56 Typical High $4,897.79 | Facility | None | $524.81 | $602.56 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $426.58 Median $549.54 Typical High $602.56 | Professional | None | $426.58 | $549.54 | $602.56 |
BCBS Michigan Setting Facility Modifier None Typical Low $724.44 Median $741.31 Typical High $1,258.93 | Facility | None | $724.44 | $741.31 | $1,258.93 |
BCBS Michigan Setting Professional Modifier None Typical Low $123.03 Median $660.69 Typical High $933.25 | Professional | None | $123.03 | $660.69 | $933.25 |
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 $309.03 Median $467.74 Typical High $758.58 | Professional | None | $309.03 | $467.74 | $758.58 |
Health Alliance Plan Setting Facility Modifier None Typical Low $575.44 Median $1,071.52 Typical High $4,897.79 | Facility | None | $575.44 | $1,071.52 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $380.19 Median $501.19 Typical High $602.56 | Professional | None | $380.19 | $501.19 | $602.56 |
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 $309.03 Median $436.52 Typical High $630.96 | Professional | None | $309.03 | $436.52 | $630.96 |
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 $380.19 Median $436.52 Typical High $501.19 | Professional | None | $380.19 | $436.52 | $501.19 |
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 $263.03 Median $275.42 Typical High $302.00 | Professional | 52 · Reduced service | $263.03 | $275.42 | $302.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $104.71 Median $109.65 Typical High $120.23 | Professional | 53 · Discontinued | $104.71 | $109.65 | $120.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $398.11 Median $407.38 Typical High $457.09 | Professional | 54 · Surgery only | $398.11 | $407.38 | $457.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $79.43 Median $81.28 Typical High $91.20 | Professional | 55 · Aftercare only | $79.43 | $81.28 | $91.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $52.48 Median $54.95 Typical High $60.26 | Professional | 56 · Pre-op care only | $52.48 | $54.95 | $60.26 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $371.54 Median $380.19 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $371.54 | $380.19 | $426.58 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $1,000.00 Median $1,000.00 Typical High $1,230.27 | Professional | 50 · Both sides | $1,000.00 | $1,000.00 | $1,230.27 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $263.03 Median $269.15 Typical High $302.00 | Professional | 52 · Reduced service | $263.03 | $269.15 | $302.00 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $104.71 Median $109.65 Typical High $120.23 | Professional | 53 · Discontinued | $104.71 | $109.65 | $120.23 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $389.05 Median $407.38 Typical High $446.68 | Professional | 54 · Surgery only | $389.05 | $407.38 | $446.68 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $77.62 Median $81.28 Typical High $89.13 | Professional | 55 · Aftercare only | $77.62 | $81.28 | $89.13 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $52.48 Median $53.70 Typical High $60.26 | Professional | 56 · Pre-op care only | $52.48 | $53.70 | $60.26 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $363.08 Median $380.19 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $363.08 | $380.19 | $416.87 |
Where Michigan sits
The same service costs 5.3 times more in New York than in Delaware. 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
NY $3,063DE $576
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.