How much rates vary
Facilitymedian $2,512 · 10th to 90th $380 to $5,012Professionalmedian $316 · 10th to 90th $224 to $398
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 $281.84 Median $371.54 Typical High $4,897.79 | Facility | None | $281.84 | $371.54 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $257.04 Median $309.03 Typical High $380.19 | Professional | None | $257.04 | $309.03 | $380.19 |
Ambetter Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | None | $223.87 | $223.87 | $223.87 |
BCBS Michigan Setting Facility Modifier None Typical Low $2,511.89 Median $2,570.40 Typical High $4,365.16 | Facility | None | $2,511.89 | $2,570.40 | $4,365.16 |
BCBS Michigan Setting Professional Modifier None Typical Low $54.95 Median $323.59 Typical High $436.52 | Professional | None | $54.95 | $323.59 | $436.52 |
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 $213.80 Median $302.00 Typical High $501.19 | Professional | None | $213.80 | $302.00 | $501.19 |
Health Alliance Plan Setting Facility Modifier None Typical Low $316.23 Median $1,230.27 Typical High $6,918.31 | Facility | None | $316.23 | $1,230.27 | $6,918.31 |
Health Alliance Plan Setting Professional Modifier None Typical Low $263.03 Median $331.13 Typical High $407.38 | Professional | None | $263.03 | $331.13 | $407.38 |
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 $213.80 Median $275.42 Typical High $446.68 | Professional | None | $213.80 | $275.42 | $446.68 |
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 $257.04 Median $316.23 Typical High $398.11 | Professional | None | $257.04 | $316.23 | $398.11 |
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 $141.25 Median $147.91 Typical High $186.21 | Professional | 52 · Reduced service | $141.25 | $147.91 | $186.21 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $60.26 Typical High $74.13 | Professional | 53 · Discontinued | $56.23 | $60.26 | $74.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $223.87 Typical High $281.84 | Professional | 54 · Surgery only | $208.93 | $223.87 | $281.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $42.66 Median $44.67 Typical High $56.23 | Professional | 55 · Aftercare only | $42.66 | $44.67 | $56.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $30.20 Typical High $37.15 | Professional | 56 · Pre-op care only | $28.18 | $30.20 | $37.15 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $194.98 Median $208.93 Typical High $263.03 | Professional | 78 · Unplanned return to OR | $194.98 | $208.93 | $263.03 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $138.04 Median $144.54 Typical High $181.97 | Professional | 52 · Reduced service | $138.04 | $144.54 | $181.97 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $54.95 Median $57.54 Typical High $72.44 | Professional | 53 · Discontinued | $54.95 | $57.54 | $72.44 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $213.80 Typical High $275.42 | Professional | 54 · Surgery only | $208.93 | $213.80 | $275.42 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $43.65 Typical High $54.95 | Professional | 55 · Aftercare only | $41.69 | $43.65 | $54.95 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $27.54 Median $28.84 Typical High $36.31 | Professional | 56 · Pre-op care only | $27.54 | $28.84 | $36.31 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $194.98 Median $199.53 Typical High $257.04 | Professional | 78 · Unplanned return to OR | $194.98 | $199.53 | $257.04 |
Where Michigan sits
The same service costs 8.5 times more in Alaska than in West Virginia. 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
AK $5,029WV $590
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.