How much rates vary
Facilitymedian $1,778 · 10th to 90th $603 to $3,715Professionalmedian $186 · 10th to 90th $120 to $204
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 $186.21 Median $2,884.03 Typical High $4,897.79 | Facility | None | $186.21 | $2,884.03 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $154.88 Median $194.98 Typical High $199.53 | Professional | None | $154.88 | $194.98 | $199.53 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,778.28 Median $1,819.70 Typical High $3,090.30 | Facility | None | $1,778.28 | $1,819.70 | $3,090.30 |
BCBS Michigan Setting Professional Modifier None Typical Low $33.11 Median $181.97 Typical High $194.98 | Professional | None | $33.11 | $181.97 | $194.98 |
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 $109.65 Median $194.98 Typical High $501.19 | Professional | None | $109.65 | $194.98 | $501.19 |
Health Alliance Plan Setting Facility Modifier None Typical Low $371.54 Median $1,202.26 Typical High $4,897.79 | Facility | None | $371.54 | $1,202.26 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $151.36 Median $190.55 Typical High $223.87 | Professional | None | $151.36 | $190.55 | $223.87 |
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 $109.65 Median $165.96 Typical High $446.68 | Professional | None | $109.65 | $165.96 | $446.68 |
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 $158.49 Median $177.83 Typical High $239.88 | Professional | None | $158.49 | $177.83 | $239.88 |
10 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 $85.11 Median $97.72 Typical High $100.00 | Professional | 52 · Reduced service | $85.11 | $97.72 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $38.90 Typical High $39.81 | Professional | 53 · Discontinued | $33.88 | $38.90 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $125.89 Median $144.54 Typical High $151.36 | Professional | 54 · Surgery only | $125.89 | $144.54 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $28.84 Typical High $30.20 | Professional | 55 · Aftercare only | $25.70 | $28.84 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $19.50 Typical High $19.95 | Professional | 56 · Pre-op care only | $16.98 | $19.50 | $19.95 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $91.20 Median $95.50 Typical High $95.50 | Professional | 52 · Reduced service | $91.20 | $95.50 | $95.50 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $38.02 Typical High $38.02 | Professional | 53 · Discontinued | $37.15 | $38.02 | $38.02 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $144.54 Typical High $144.54 | Professional | 54 · Surgery only | $138.04 | $144.54 | $144.54 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $28.84 Typical High $28.84 | Professional | 55 · Aftercare only | $27.54 | $28.84 | $28.84 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $19.05 Typical High $19.05 | Professional | 56 · Pre-op care only | $18.20 | $19.05 | $19.05 |
Where Michigan sits
The same service costs 14.3 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 $6,102MT $428
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.