How much rates vary
Facilitymedian $1,622 · 10th to 90th $813 to $3,631Professionalmedian $501 · 10th to 90th $372 to $603
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 $501.19 Median $2,884.03 Typical High $4,897.79 | Facility | None | $501.19 | $2,884.03 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $398.11 Median $501.19 Typical High $501.19 | Professional | None | $398.11 | $501.19 | $501.19 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,621.81 Median $1,659.59 Typical High $2,884.03 | Facility | None | $1,621.81 | $1,659.59 | $2,884.03 |
BCBS Michigan Setting Professional Modifier None Typical Low $95.50 Median $562.34 Typical High $602.56 | Professional | None | $95.50 | $562.34 | $602.56 |
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 $288.40 Median $524.81 Typical High $1,412.54 | Professional | None | $288.40 | $524.81 | $1,412.54 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,047.13 Median $1,318.26 Typical High $4,897.79 | Facility | None | $1,047.13 | $1,318.26 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $398.11 Median $489.78 Typical High $602.56 | Professional | None | $398.11 | $489.78 | $602.56 |
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 $288.40 Median $446.68 Typical High $1,230.27 | Professional | None | $288.40 | $446.68 | $1,230.27 |
United Setting Facility Modifier None Typical Low $602.56 Median $1,230.27 Typical High $5,248.07 | Facility | None | $602.56 | $1,230.27 | $5,248.07 |
United Setting Professional Modifier None Typical Low $436.52 Median $501.19 Typical High $645.65 | Professional | None | $436.52 | $501.19 | $645.65 |
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 $223.87 Median $251.19 Typical High $251.19 | Professional | 52 · Reduced service | $223.87 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $89.13 Median $100.00 Typical High $100.00 | Professional | 53 · Discontinued | $89.13 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $338.84 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $338.84 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $74.13 Typical High $75.86 | Professional | 55 · Aftercare only | $67.61 | $74.13 | $75.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $44.67 Median $50.12 Typical High $50.12 | Professional | 56 · Pre-op care only | $44.67 | $50.12 | $50.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $316.23 Median $346.74 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $316.23 | $346.74 | $346.74 |
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 $97.72 Median $97.72 Typical High $97.72 | Professional | 53 · Discontinued | $97.72 | $97.72 | $97.72 |
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 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $346.74 Median $346.74 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $346.74 | $346.74 | $346.74 |
Where Michigan sits
The same service costs 5.3 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 $6,601MT $1,248
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.