How much rates vary
Facilitymedian $18,197 · 10th to 90th $501 to $28,184Professionalmedian $6,166 · 10th to 90th $3,890 to $7,079
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 $4,897.79 Median $6,309.57 Typical High $6,918.31 | Facility | None | $4,897.79 | $6,309.57 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $5,623.41 Median $6,760.83 Typical High $6,760.83 | Professional | None | $5,623.41 | $6,760.83 | $6,760.83 |
BCBS Michigan Setting Facility Modifier None Typical Low $18,197.01 Median $18,620.87 Typical High $32,359.37 | Facility | None | $18,197.01 | $18,620.87 | $32,359.37 |
BCBS Michigan Setting Professional Modifier None Typical Low $1,174.90 Median $4,365.16 Typical High $6,918.31 | Professional | None | $1,174.90 | $4,365.16 | $6,918.31 |
Cigna Setting Professional Modifier None Typical Low $9,772.37 Median $14,125.38 Typical High $15,848.93 | Professional | None | $9,772.37 | $14,125.38 | $15,848.93 |
Health Alliance Plan Setting Facility Modifier None Typical Low $4,897.79 Median $14,125.38 Typical High $15,848.93 | Facility | None | $4,897.79 | $14,125.38 | $15,848.93 |
Health Alliance Plan Setting Professional Modifier None Typical Low $5,370.32 Median $6,456.54 Typical High $7,762.47 | Professional | None | $5,370.32 | $6,456.54 | $7,762.47 |
Priority Health Setting Professional Modifier None Typical Low $9,772.37 Median $9,772.37 Typical High $14,125.38 | Professional | None | $9,772.37 | $9,772.37 | $14,125.38 |
United Setting Facility Modifier None Typical Low $426.58 Median $549.54 Typical High $3,311.31 | Facility | None | $426.58 | $549.54 | $3,311.31 |
United Setting Professional Modifier None Typical Low $3,981.07 Median $5,888.44 Typical High $7,413.10 | Professional | None | $3,981.07 | $5,888.44 | $7,413.10 |
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 $2,818.38 Median $3,388.44 Typical High $3,388.44 | Professional | 52 · Reduced service | $2,818.38 | $3,388.44 | $3,388.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1,122.02 Median $1,348.96 Typical High $1,348.96 | Professional | 53 · Discontinued | $1,122.02 | $1,348.96 | $1,348.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $4,168.69 Median $5,011.87 Typical High $5,011.87 | Professional | 54 · Surgery only | $4,168.69 | $5,011.87 | $5,011.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $831.76 Median $1,000.00 Typical High $1,023.29 | Professional | 55 · Aftercare only | $831.76 | $1,000.00 | $1,023.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $562.34 Median $676.08 Typical High $676.08 | Professional | 56 · Pre-op care only | $562.34 | $676.08 | $676.08 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,890.45 Median $4,677.35 Typical High $4,677.35 | Professional | 78 · Unplanned return to OR | $3,890.45 | $4,677.35 | $4,677.35 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $3,090.30 Median $3,235.94 Typical High $3,235.94 | Professional | 52 · Reduced service | $3,090.30 | $3,235.94 | $3,235.94 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $1,230.27 Median $1,288.25 Typical High $1,288.25 | Professional | 53 · Discontinued | $1,230.27 | $1,288.25 | $1,288.25 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $4,677.35 Median $4,786.30 Typical High $4,786.30 | Professional | 54 · Surgery only | $4,677.35 | $4,786.30 | $4,786.30 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $933.25 Median $977.24 Typical High $977.24 | Professional | 55 · Aftercare only | $933.25 | $977.24 | $977.24 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $616.60 Median $645.65 Typical High $645.65 | Professional | 56 · Pre-op care only | $616.60 | $645.65 | $645.65 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $4,365.16 Median $4,466.84 Typical High $4,466.84 | Professional | 78 · Unplanned return to OR | $4,365.16 | $4,466.84 | $4,466.84 |
Where Michigan sits
The same service costs 8.4 times more in Wisconsin than in Texas. 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
WI $28,671TX $3,407
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.