How much rates vary
Facilitymedian $2,884 · 10th to 90th $490 to $5,754Professionalmedian $245 · 10th to 90th $170 to $275
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 $245.47 Median $263.03 Typical High $4,897.79 | Facility | None | $245.47 | $263.03 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $199.53 Median $257.04 Typical High $269.15 | Professional | None | $199.53 | $257.04 | $269.15 |
Ambetter Setting Professional Modifier None Typical Low $79.43 Median $79.43 Typical High $79.43 | Professional | None | $79.43 | $79.43 | $79.43 |
BCBS Michigan Setting Facility Modifier None Typical Low $2,884.03 Median $2,884.03 Typical High $5,011.87 | Facility | None | $2,884.03 | $2,884.03 | $5,011.87 |
BCBS Michigan Setting Professional Modifier None Typical Low $147.91 Median $251.19 Typical High $251.19 | Professional | None | $147.91 | $251.19 | $251.19 |
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 $141.25 Median $257.04 Typical High $660.69 | Professional | None | $141.25 | $257.04 | $660.69 |
Health Alliance Plan Setting Facility Modifier None Typical Low $263.03 Median $2,884.03 Typical High $7,762.47 | Facility | None | $263.03 | $2,884.03 | $7,762.47 |
Health Alliance Plan Setting Professional Modifier None Typical Low $194.98 Median $245.47 Typical High $295.12 | Professional | None | $194.98 | $245.47 | $295.12 |
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 $141.25 Median $218.78 Typical High $588.84 | Professional | None | $141.25 | $218.78 | $588.84 |
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 $208.93 Median $234.42 Typical High $316.23 | Professional | None | $208.93 | $234.42 | $316.23 |
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 $112.20 Median $128.82 Typical High $131.83 | Professional | 52 · Reduced service | $112.20 | $128.82 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $44.67 Median $51.29 Typical High $52.48 | Professional | 53 · Discontinued | $44.67 | $51.29 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $165.96 Median $190.55 Typical High $194.98 | Professional | 54 · Surgery only | $165.96 | $190.55 | $194.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.11 Median $38.02 Typical High $38.90 | Professional | 55 · Aftercare only | $33.11 | $38.02 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.39 Median $25.70 Typical High $26.30 | Professional | 56 · Pre-op care only | $22.39 | $25.70 | $26.30 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $120.23 Median $125.89 Typical High $125.89 | Professional | 52 · Reduced service | $120.23 | $125.89 | $125.89 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $47.86 Median $50.12 Typical High $50.12 | Professional | 53 · Discontinued | $47.86 | $50.12 | $50.12 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $181.97 Median $186.21 Typical High $186.21 | Professional | 54 · Surgery only | $181.97 | $186.21 | $186.21 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $36.31 Median $37.15 Typical High $37.15 | Professional | 55 · Aftercare only | $36.31 | $37.15 | $37.15 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $23.99 Median $25.12 Typical High $25.12 | Professional | 56 · Pre-op care only | $23.99 | $25.12 | $25.12 |
Where Michigan sits
The same service costs 11.3 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 $6,301MT $557
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.