How much rates vary
Facilitymedian $7,943 · 10th to 90th $1,175 to $16,982Professionalmedian $1,175 · 10th to 90th $832 to $1,380
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 $1,096.48 Median $1,202.26 Typical High $5,754.40 | Facility | None | $1,096.48 | $1,202.26 | $5,754.40 |
Aetna Setting Professional Modifier None Typical Low $891.25 Median $1,174.90 Typical High $1,230.27 | Professional | None | $891.25 | $1,174.90 | $1,230.27 |
Ambetter Setting Professional Modifier None Typical Low $870.96 Median $870.96 Typical High $870.96 | Professional | None | $870.96 | $870.96 | $870.96 |
BCBS Michigan Setting Facility Modifier None Typical Low $10,964.78 Median $11,220.18 Typical High $19,054.61 | Facility | None | $10,964.78 | $11,220.18 | $19,054.61 |
BCBS Michigan Setting Professional Modifier None Typical Low $213.80 Median $1,258.93 Typical High $1,258.93 | Professional | None | $213.80 | $1,258.93 | $1,258.93 |
Cigna Setting Facility Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Facility | None | $2,089.30 | $2,089.30 | $2,089.30 |
Cigna Setting Professional Modifier None Typical Low $691.83 Median $1,230.27 Typical High $2,818.38 | Professional | None | $691.83 | $1,230.27 | $2,818.38 |
Health Alliance Plan Setting Facility Modifier None Typical Low $1,202.26 Median $4,570.88 Typical High $16,982.44 | Facility | None | $1,202.26 | $4,570.88 | $16,982.44 |
Health Alliance Plan Setting Professional Modifier None Typical Low $933.25 Median $1,122.02 Typical High $1,412.54 | Professional | None | $933.25 | $1,122.02 | $1,412.54 |
Priority Health Setting Facility Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Facility | None | $2,089.30 | $2,089.30 | $2,089.30 |
Priority Health Setting Professional Modifier None Typical Low $691.83 Median $977.24 Typical High $2,511.89 | Professional | None | $691.83 | $977.24 | $2,511.89 |
United Setting Facility Modifier None Typical Low $851.14 Median $2,238.72 Typical High $7,943.28 | Facility | None | $851.14 | $2,238.72 | $7,943.28 |
United Setting Professional Modifier None Typical Low $1,023.29 Median $1,174.90 Typical High $1,479.11 | Professional | None | $1,023.29 | $1,174.90 | $1,479.11 |
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 $501.19 Median $575.44 Typical High $575.44 | Professional | 52 · Reduced service | $501.19 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $234.42 Typical High $234.42 | Professional | 53 · Discontinued | $199.53 | $234.42 | $234.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $870.96 Typical High $870.96 | Professional | 54 · Surgery only | $741.31 | $870.96 | $870.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $173.78 Typical High $173.78 | Professional | 55 · Aftercare only | $147.91 | $173.78 | $173.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $117.49 Typical High $117.49 | Professional | 56 · Pre-op care only | $100.00 | $117.49 | $117.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $812.83 Typical High $812.83 | Professional | 78 · Unplanned return to OR | $691.83 | $812.83 | $812.83 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $537.03 Median $562.34 Typical High $562.34 | Professional | 52 · Reduced service | $537.03 | $562.34 | $562.34 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $213.80 Median $223.87 Typical High $223.87 | Professional | 53 · Discontinued | $213.80 | $223.87 | $223.87 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $831.76 Typical High $831.76 | Professional | 54 · Surgery only | $812.83 | $831.76 | $831.76 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $162.18 Median $169.82 Typical High $169.82 | Professional | 55 · Aftercare only | $162.18 | $169.82 | $169.82 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $107.15 Median $112.20 Typical High $112.20 | Professional | 56 · Pre-op care only | $107.15 | $112.20 | $112.20 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $776.25 Typical High $776.25 | Professional | 78 · Unplanned return to OR | $758.58 | $776.25 | $776.25 |
Where Michigan sits
The same service costs 4.2 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 $11,551MT $2,762
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.