How much rates vary
Facilitymedian $1,950 · 10th to 90th $813 to $4,074Professionalmedian $575 · 10th to 90th $135 to $1,000
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 $588.84 Median $2,884.03 Typical High $4,897.79 | Facility | None | $588.84 | $2,884.03 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $457.09 Median $602.56 Typical High $645.65 | Professional | None | $457.09 | $602.56 | $645.65 |
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 $114.82 Median $630.96 Typical High $1,000.00 | Professional | None | $114.82 | $630.96 | $1,000.00 |
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 $346.74 Median $575.44 Typical High $1,479.11 | Professional | None | $346.74 | $575.44 | $1,479.11 |
Health Alliance Plan Setting Facility Modifier None Typical Low $954.99 Median $1,148.15 Typical High $4,897.79 | Facility | None | $954.99 | $1,148.15 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $436.52 Median $575.44 Typical High $676.08 | Professional | None | $436.52 | $575.44 | $676.08 |
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 $346.74 Median $512.86 Typical High $1,202.26 | Professional | None | $346.74 | $512.86 | $1,202.26 |
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 $436.52 Median $512.86 Typical High $691.83 | Professional | None | $436.52 | $512.86 | $691.83 |
12 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 $281.84 Median $302.00 Typical High $309.03 | Professional | 52 · Reduced service | $281.84 | $302.00 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $112.20 Median $123.03 Typical High $125.89 | Professional | 53 · Discontinued | $112.20 | $123.03 | $125.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $426.58 Median $457.09 Typical High $467.74 | Professional | 54 · Surgery only | $426.58 | $457.09 | $467.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $85.11 Median $91.20 Typical High $93.33 | Professional | 55 · Aftercare only | $85.11 | $91.20 | $93.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $56.23 Median $60.26 Typical High $63.10 | Professional | 56 · Pre-op care only | $56.23 | $60.26 | $63.10 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $398.11 Median $426.58 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $398.11 | $426.58 | $436.52 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $295.12 Median $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $295.12 | $309.03 | $309.03 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $117.49 Median $123.03 Typical High $123.03 | Professional | 53 · Discontinued | $117.49 | $123.03 | $123.03 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $446.68 Median $457.09 Typical High $457.09 | Professional | 54 · Surgery only | $446.68 | $457.09 | $457.09 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $89.13 Median $91.20 Typical High $91.20 | Professional | 55 · Aftercare only | $89.13 | $91.20 | $91.20 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $58.88 Median $61.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $58.88 | $61.66 | $61.66 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $416.87 Median $426.58 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $416.87 | $426.58 | $426.58 |
Where Michigan sits
The same service costs 3.6 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 $5,175MT $1,450
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.