How much rates vary
Facilitymedian $2,630 · 10th to 90th $794 to $4,898Professionalmedian $708 · 10th to 90th $209 to $1,148
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 $251.19 Median $977.24 Typical High $4,897.79 | Facility | None | $251.19 | $977.24 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $213.80 Median $707.95 Typical High $1,000.00 | Professional | None | $213.80 | $707.95 | $1,000.00 |
Ambetter Setting Professional Modifier None Typical Low $707.95 Median $707.95 Typical High $707.95 | Professional | None | $707.95 | $707.95 | $707.95 |
BCBS Michigan Setting Facility Modifier None Typical Low $2,630.27 Median $2,691.53 Typical High $4,570.88 | Facility | None | $2,630.27 | $2,691.53 | $4,570.88 |
BCBS Michigan Setting Professional Modifier None Typical Low $51.29 Median $257.04 Typical High $1,258.93 | Professional | None | $51.29 | $257.04 | $1,258.93 |
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 $194.98 Median $338.84 Typical High $1,288.25 | Professional | None | $194.98 | $338.84 | $1,288.25 |
Health Alliance Plan Setting Facility Modifier None Typical Low $812.83 Median $2,187.76 Typical High $4,897.79 | Facility | None | $812.83 | $2,187.76 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $239.88 Median $870.96 Typical High $1,071.52 | Professional | None | $239.88 | $870.96 | $1,071.52 |
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 $134.90 Median $338.84 Typical High $1,047.13 | Professional | None | $134.90 | $338.84 | $1,047.13 |
United Setting Facility Modifier None Typical Low $660.69 Median $1,548.82 Typical High $6,456.54 | Facility | None | $660.69 | $1,548.82 | $6,456.54 |
United Setting Professional Modifier None Typical Low $245.47 Median $758.58 Typical High $1,148.15 | Professional | None | $245.47 | $758.58 | $1,148.15 |
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 $125.89 Median $295.12 Typical High $501.19 | Professional | 52 · Reduced service | $125.89 | $295.12 | $501.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $50.12 Median $120.23 Typical High $199.53 | Professional | 53 · Discontinued | $50.12 | $120.23 | $199.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $186.21 Median $446.68 Typical High $741.31 | Professional | 54 · Surgery only | $186.21 | $446.68 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $37.15 Median $89.13 Typical High $151.36 | Professional | 55 · Aftercare only | $37.15 | $89.13 | $151.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.12 Median $60.26 Typical High $100.00 | Professional | 56 · Pre-op care only | $25.12 | $60.26 | $100.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $173.78 Median $416.87 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $173.78 | $416.87 | $691.83 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $120.23 Median $125.89 Typical High $512.86 | Professional | 52 · Reduced service | $120.23 | $125.89 | $512.86 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $47.86 Median $50.12 Typical High $204.17 | Professional | 53 · Discontinued | $47.86 | $50.12 | $204.17 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $181.97 Median $190.55 Typical High $776.25 | Professional | 54 · Surgery only | $181.97 | $190.55 | $776.25 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $36.31 Median $38.02 Typical High $154.88 | Professional | 55 · Aftercare only | $36.31 | $38.02 | $154.88 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $23.99 Median $25.12 Typical High $102.33 | Professional | 56 · Pre-op care only | $23.99 | $25.12 | $102.33 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $169.82 Median $177.83 Typical High $724.44 | Professional | 78 · Unplanned return to OR | $169.82 | $177.83 | $724.44 |
Where Michigan sits
The same service costs 5.1 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 $7,315MT $1,443
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.