How much rates vary
Facilitymedian $3,802 · 10th to 90th $646 to $6,918Professionalmedian $575 · 10th to 90th $398 to $912
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 $549.54 Median $575.44 Typical High $4,897.79 | Facility | None | $549.54 | $575.44 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $457.09 Median $549.54 Typical High $616.60 | Professional | None | $457.09 | $549.54 | $616.60 |
BCBS Michigan Setting Facility Modifier None Typical Low $3,801.89 Median $3,801.89 Typical High $6,606.93 | Facility | None | $3,801.89 | $3,801.89 | $6,606.93 |
BCBS Michigan Setting Professional Modifier None Typical Low $380.19 Median $645.65 Typical High $912.01 | Professional | None | $380.19 | $645.65 | $912.01 |
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 $323.59 Median $588.84 Typical High $1,548.82 | Professional | None | $323.59 | $588.84 | $1,548.82 |
Health Alliance Plan Setting Facility Modifier None Typical Low $549.54 Median $1,995.26 Typical High $8,912.51 | Facility | None | $549.54 | $1,995.26 | $8,912.51 |
Health Alliance Plan Setting Professional Modifier None Typical Low $489.78 Median $549.54 Typical High $758.58 | Professional | None | $489.78 | $549.54 | $758.58 |
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 $323.59 Median $549.54 Typical High $1,380.38 | Professional | None | $323.59 | $549.54 | $1,380.38 |
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 $512.86 Median $616.60 Typical High $776.25 | Professional | None | $512.86 | $616.60 | $776.25 |
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 $269.15 Median $275.42 Typical High $275.42 | Professional | 52 · Reduced service | $269.15 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $109.65 Median $112.20 Typical High $112.20 | Professional | 53 · Discontinued | $109.65 | $112.20 | $112.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $407.38 Median $416.87 Typical High $416.87 | Professional | 54 · Surgery only | $407.38 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $81.28 Median $83.18 Typical High $83.18 | Professional | 55 · Aftercare only | $81.28 | $83.18 | $83.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $53.70 Median $54.95 Typical High $56.23 | Professional | 56 · Pre-op care only | $53.70 | $54.95 | $56.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $380.19 Median $389.05 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $380.19 | $389.05 | $389.05 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $977.24 Median $977.24 Typical High $977.24 | Professional | 50 · Both sides | $977.24 | $977.24 | $977.24 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $275.42 Median $275.42 Typical High $275.42 | Professional | 52 · Reduced service | $275.42 | $275.42 | $275.42 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | 53 · Discontinued | $109.65 | $109.65 | $109.65 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | 54 · Surgery only | $416.87 | $416.87 | $416.87 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | 55 · Aftercare only | $83.18 | $83.18 | $83.18 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $54.95 Median $54.95 Typical High $54.95 | Professional | 56 · Pre-op care only | $54.95 | $54.95 | $54.95 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $389.05 Median $389.05 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $389.05 | $389.05 | $389.05 |
Where Michigan sits
The same service costs 5.5 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 $7,406MT $1,352
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.