How much rates vary
Facilitymedian $2,570 · 10th to 90th $562 to $4,898Professionalmedian $234 · 10th to 90th $166 to $380
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 $218.78 Median $616.60 Typical High $4,897.79 | Facility | None | $218.78 | $616.60 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $234.42 Typical High $239.88 | Professional | None | $173.78 | $234.42 | $239.88 |
BCBS Michigan Setting Facility Modifier None Typical Low $2,570.40 Median $2,570.40 Typical High $4,466.84 | Facility | None | $2,570.40 | $2,570.40 | $4,466.84 |
BCBS Michigan Setting Professional Modifier None Typical Low $158.49 Median $269.15 Typical High $380.19 | Professional | None | $158.49 | $269.15 | $380.19 |
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 $138.04 Median $245.47 Typical High $616.60 | Professional | None | $138.04 | $245.47 | $616.60 |
Health Alliance Plan Setting Facility Modifier None Typical Low $245.47 Median $1,174.90 Typical High $4,897.79 | Facility | None | $245.47 | $1,174.90 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $190.55 Median $223.87 Typical High $288.40 | Professional | None | $190.55 | $223.87 | $288.40 |
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 $138.04 Median $199.53 Typical High $549.54 | Professional | None | $138.04 | $199.53 | $549.54 |
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 $208.93 Median $239.88 Typical High $295.12 | Professional | None | $208.93 | $239.88 | $295.12 |
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 $100.00 Median $117.49 Typical High $117.49 | Professional | 52 · Reduced service | $100.00 | $117.49 | $117.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $46.77 Typical High $46.77 | Professional | 53 · Discontinued | $39.81 | $46.77 | $46.77 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $151.36 Median $173.78 Typical High $173.78 | Professional | 54 · Surgery only | $151.36 | $173.78 | $173.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.20 Median $35.48 Typical High $35.48 | Professional | 55 · Aftercare only | $30.20 | $35.48 | $35.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $23.44 Typical High $23.44 | Professional | 56 · Pre-op care only | $19.95 | $23.44 | $23.44 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $141.25 Median $162.18 Typical High $162.18 | Professional | 78 · Unplanned return to OR | $141.25 | $162.18 | $162.18 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $107.15 Median $112.20 Typical High $112.20 | Professional | 52 · Reduced service | $107.15 | $112.20 | $112.20 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $42.66 Median $44.67 Typical High $44.67 | Professional | 53 · Discontinued | $42.66 | $44.67 | $44.67 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $162.18 Median $165.96 Typical High $165.96 | Professional | 54 · Surgery only | $162.18 | $165.96 | $165.96 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $33.88 Typical High $33.88 | Professional | 55 · Aftercare only | $32.36 | $33.88 | $33.88 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $21.38 Median $22.39 Typical High $22.39 | Professional | 56 · Pre-op care only | $21.38 | $22.39 | $22.39 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $151.36 Median $154.88 Typical High $154.88 | Professional | 78 · Unplanned return to OR | $151.36 | $154.88 | $154.88 |
Where Michigan sits
The same service costs 8.1 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 $4,634MT $570
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.