How much rates vary
Facilitymedian $4,898 · 10th to 90th $891 to $11,482Professionalmedian $513 · 10th to 90th $363 to $794
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 $512.86 Median $524.81 Typical High $4,897.79 | Facility | None | $512.86 | $524.81 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $416.87 Median $512.86 Typical High $537.03 | Professional | None | $416.87 | $512.86 | $537.03 |
Ambetter Setting Professional Modifier None Typical Low $363.08 Median $363.08 Typical High $407.38 | Professional | None | $363.08 | $363.08 | $407.38 |
BCBS Michigan Setting Facility Modifier None Typical Low $3,981.07 Median $5,011.87 Typical High $12,302.69 | Facility | None | $3,981.07 | $5,011.87 | $12,302.69 |
BCBS Michigan Setting Professional Modifier None Typical Low $107.15 Median $562.34 Typical High $794.33 | Professional | None | $107.15 | $562.34 | $794.33 |
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 $288.40 Median $524.81 Typical High $1,380.38 | Professional | None | $288.40 | $524.81 | $1,380.38 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,258.93 Median $6,456.54 Typical High $11,748.98 | Facility | None | $1,258.93 | $6,456.54 | $11,748.98 |
Health Alliance Plan Setting Professional Modifier None Typical Low $426.58 Median $489.78 Typical High $660.69 | Professional | None | $426.58 | $489.78 | $660.69 |
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 $288.40 Median $501.19 Typical High $1,230.27 | Professional | None | $288.40 | $501.19 | $1,230.27 |
United Setting Facility Modifier None Typical Low $851.14 Median $2,290.87 Typical High $7,943.28 | Facility | None | $851.14 | $2,290.87 | $7,943.28 |
United Setting Professional Modifier None Typical Low $457.09 Median $562.34 Typical High $660.69 | Professional | None | $457.09 | $562.34 | $660.69 |
11 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 $229.09 Median $257.04 Typical High $257.04 | Professional | 52 · Reduced service | $229.09 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $91.20 Median $102.33 Typical High $102.33 | Professional | 53 · Discontinued | $91.20 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $338.84 Median $389.05 Typical High $389.05 | Professional | 54 · Surgery only | $338.84 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $77.62 Typical High $77.62 | Professional | 55 · Aftercare only | $67.61 | $77.62 | $77.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $45.71 Median $51.29 Typical High $51.29 | Professional | 56 · Pre-op care only | $45.71 | $51.29 | $51.29 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $851.14 Median $851.14 Typical High $851.14 | Professional | 50 · Both sides | $851.14 | $851.14 | $851.14 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $245.47 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $245.47 | $245.47 | $245.47 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $100.00 Typical High $100.00 | Professional | 53 · Discontinued | $100.00 | $100.00 | $100.00 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $371.54 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $371.54 | $371.54 | $371.54 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $74.13 | $74.13 | $74.13 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $48.98 Median $48.98 Typical High $48.98 | Professional | 56 · Pre-op care only | $48.98 | $48.98 | $48.98 |
Where Michigan sits
The same service costs 7.3 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 $8,816MT $1,205
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.