How much rates vary
Facilitymedian $6,918 · 10th to 90th $1,023 to $10,715Professionalmedian $933 · 10th to 90th $617 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 $933.25 Median $1,000.00 Typical High $6,918.31 | Facility | None | $933.25 | $1,000.00 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $645.65 Median $954.99 Typical High $1,023.29 | Professional | None | $645.65 | $954.99 | $1,023.29 |
BCBS Michigan Setting Facility Modifier None Typical Low $6,918.31 Median $7,079.46 Typical High $12,022.64 | Facility | None | $6,918.31 | $7,079.46 | $12,022.64 |
BCBS Michigan Setting Professional Modifier None Typical Low $251.19 Median $1,000.00 Typical High $1,348.96 | Professional | None | $251.19 | $1,000.00 | $1,348.96 |
Cigna Setting Facility Modifier None Typical Low $776.25 Median $776.25 Typical High $776.25 | Facility | None | $776.25 | $776.25 | $776.25 |
Cigna Setting Professional Modifier None Typical Low $512.86 Median $851.14 Typical High $2,630.27 | Professional | None | $512.86 | $851.14 | $2,630.27 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,000.00 Median $2,511.89 Typical High $6,918.31 | Facility | None | $1,000.00 | $2,511.89 | $6,918.31 |
Health Alliance Plan Setting Professional Modifier None Typical Low $724.44 Median $891.25 Typical High $1,096.48 | Professional | None | $724.44 | $891.25 | $1,096.48 |
Priority Health Setting Facility Modifier None Typical Low $776.25 Median $776.25 Typical High $776.25 | Facility | None | $776.25 | $776.25 | $776.25 |
Priority Health Setting Professional Modifier None Typical Low $489.78 Median $851.14 Typical High $2,630.27 | Professional | None | $489.78 | $851.14 | $2,630.27 |
United Setting Facility Modifier None Typical Low $891.25 Median $2,818.38 Typical High $9,549.93 | Facility | None | $891.25 | $2,818.38 | $9,549.93 |
United Setting Professional Modifier None Typical Low $831.76 Median $1,023.29 Typical High $1,202.26 | Professional | None | $831.76 | $1,023.29 | $1,202.26 |
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 $371.54 Median $467.74 Typical High $489.78 | Professional | 52 · Reduced service | $371.54 | $467.74 | $489.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $190.55 Typical High $194.98 | Professional | 53 · Discontinued | $147.91 | $190.55 | $194.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $707.95 Typical High $741.31 | Professional | 54 · Surgery only | $549.54 | $707.95 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $141.25 Typical High $147.91 | Professional | 55 · Aftercare only | $109.65 | $141.25 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $74.13 Median $95.50 Typical High $97.72 | Professional | 56 · Pre-op care only | $74.13 | $95.50 | $97.72 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $660.69 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $512.86 | $660.69 | $691.83 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $446.68 Median $457.09 Typical High $457.09 | Professional | 52 · Reduced service | $446.68 | $457.09 | $457.09 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $177.83 Median $181.97 Typical High $181.97 | Professional | 53 · Discontinued | $177.83 | $181.97 | $181.97 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $660.69 Median $691.83 Typical High $691.83 | Professional | 54 · Surgery only | $660.69 | $691.83 | $691.83 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $131.83 Median $138.04 Typical High $138.04 | Professional | 55 · Aftercare only | $131.83 | $138.04 | $138.04 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $89.13 Median $91.20 Typical High $91.20 | Professional | 56 · Pre-op care only | $89.13 | $91.20 | $91.20 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $616.60 Median $645.65 Typical High $645.65 | Professional | 78 · Unplanned return to OR | $616.60 | $645.65 | $645.65 |
Where Michigan sits
The same service costs 5.3 times more in Wisconsin 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
WI $10,556MT $2,002
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.