How much rates vary
Facilitymedian $6,026 · 10th to 90th $891 to $11,220Professionalmedian $724 · 10th to 90th $501 to $891
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 $741.31 Median $776.25 Typical High $6,918.31 | Facility | None | $741.31 | $776.25 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $602.56 Median $741.31 Typical High $794.33 | Professional | None | $602.56 | $741.31 | $794.33 |
Ambetter Setting Professional Modifier None Typical Low $537.03 Median $537.03 Typical High $537.03 | Professional | None | $537.03 | $537.03 | $537.03 |
BCBS Michigan Setting Facility Modifier None Typical Low $6,025.60 Median $6,165.95 Typical High $10,471.29 | Facility | None | $6,025.60 | $6,165.95 | $10,471.29 |
BCBS Michigan Setting Professional Modifier None Typical Low $144.54 Median $537.03 Typical High $1,288.25 | Professional | None | $144.54 | $537.03 | $1,288.25 |
Cigna Setting Facility Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,230.27 | Facility | None | $1,230.27 | $1,230.27 | $1,230.27 |
Cigna Setting Professional Modifier None Typical Low $478.63 Median $660.69 Typical High $1,258.93 | Professional | None | $478.63 | $660.69 | $1,258.93 |
Health Alliance Plan Setting Facility Modifier None Typical Low $741.31 Median $4,897.79 Typical High $15,135.61 | Facility | None | $741.31 | $4,897.79 | $15,135.61 |
Health Alliance Plan Setting Professional Modifier None Typical Low $575.44 Median $724.44 Typical High $812.83 | Professional | None | $575.44 | $724.44 | $812.83 |
Priority Health Setting Facility Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,230.27 | Facility | None | $1,230.27 | $1,230.27 | $1,230.27 |
Priority Health Setting Professional Modifier None Typical Low $457.09 Median $630.96 Typical High $1,047.13 | Professional | None | $457.09 | $630.96 | $1,047.13 |
United Setting Facility Modifier None Typical Low $891.25 Median $2,818.38 Typical High $10,000.00 | Facility | None | $891.25 | $2,818.38 | $10,000.00 |
United Setting Professional Modifier None Typical Low $630.96 Median $794.33 Typical High $870.96 | Professional | None | $630.96 | $794.33 | $870.96 |
13 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 $371.54 Typical High $371.54 | Professional | 52 · Reduced service | $371.54 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $151.36 Typical High $151.36 | Professional | 53 · Discontinued | $147.91 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $562.34 Typical High $562.34 | Professional | 54 · Surgery only | $549.54 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $112.20 Typical High $112.20 | Professional | 55 · Aftercare only | $109.65 | $112.20 | $112.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | 56 · Pre-op care only | $74.13 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $524.81 Typical High $524.81 | Professional | 78 · Unplanned return to OR | $512.86 | $524.81 | $524.81 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $1,148.15 Median $1,348.96 Typical High $1,348.96 | Professional | 50 · Both sides | $1,148.15 | $1,348.96 | $1,348.96 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $363.08 Median $363.08 Typical High $363.08 | Professional | 52 · Reduced service | $363.08 | $363.08 | $363.08 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $144.54 Typical High $144.54 | Professional | 53 · Discontinued | $144.54 | $144.54 | $144.54 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $549.54 Typical High $549.54 | Professional | 54 · Surgery only | $549.54 | $549.54 | $549.54 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | 55 · Aftercare only | $109.65 | $109.65 | $109.65 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $72.44 Typical High $72.44 | Professional | 56 · Pre-op care only | $72.44 | $72.44 | $72.44 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $512.86 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $512.86 | $512.86 | $512.86 |
Where Michigan sits
The same service costs 6.0 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 $11,096MT $1,846
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.