How much rates vary
Facilitymedian $1,738 · 10th to 90th $661 to $3,715Professionalmedian $550 · 10th to 90th $380 to $617
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 $537.03 Median $2,884.03 Typical High $4,897.79 | Facility | None | $537.03 | $2,884.03 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $436.52 Median $562.34 Typical High $575.44 | Professional | None | $436.52 | $562.34 | $575.44 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,737.80 Median $1,778.28 Typical High $3,090.30 | Facility | None | $1,737.80 | $1,778.28 | $3,090.30 |
BCBS Michigan Setting Professional Modifier None Typical Low $165.96 Median $575.44 Typical High $616.60 | Professional | None | $165.96 | $575.44 | $616.60 |
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 $316.23 Median $575.44 Typical High $1,318.26 | Professional | None | $316.23 | $575.44 | $1,318.26 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,148.15 Median $1,412.54 Typical High $4,897.79 | Facility | None | $1,148.15 | $1,412.54 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $457.09 Median $562.34 Typical High $691.83 | Professional | None | $457.09 | $562.34 | $691.83 |
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 $316.23 Median $512.86 Typical High $1,202.26 | Professional | None | $316.23 | $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 $457.09 Median $537.03 Typical High $724.44 | Professional | None | $457.09 | $537.03 | $724.44 |
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 $257.04 Median $281.84 Typical High $288.40 | Professional | 52 · Reduced service | $257.04 | $281.84 | $288.40 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $102.33 Median $112.20 Typical High $114.82 | Professional | 53 · Discontinued | $102.33 | $112.20 | $114.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $389.05 Median $416.87 Typical High $426.58 | Professional | 54 · Surgery only | $389.05 | $416.87 | $426.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $77.62 Median $83.18 Typical High $85.11 | Professional | 55 · Aftercare only | $77.62 | $83.18 | $85.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $51.29 Median $56.23 Typical High $57.54 | Professional | 56 · Pre-op care only | $51.29 | $56.23 | $57.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $363.08 Median $389.05 Typical High $398.11 | Professional | 78 · Unplanned return to OR | $363.08 | $389.05 | $398.11 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $269.15 Median $281.84 Typical High $281.84 | Professional | 52 · Reduced service | $269.15 | $281.84 | $281.84 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $107.15 Median $112.20 Typical High $112.20 | Professional | 53 · Discontinued | $107.15 | $112.20 | $112.20 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $407.38 Median $416.87 Typical High $416.87 | Professional | 54 · Surgery only | $407.38 | $416.87 | $416.87 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $81.28 Median $83.18 Typical High $83.18 | Professional | 55 · Aftercare only | $81.28 | $83.18 | $83.18 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $53.70 Median $56.23 Typical High $56.23 | Professional | 56 · Pre-op care only | $53.70 | $56.23 | $56.23 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $380.19 Median $389.05 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $380.19 | $389.05 | $389.05 |
Where Michigan sits
The same service costs 4.1 times more in Oklahoma 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
OK $5,653MT $1,368
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.