How much rates vary
Facilitymedian $1,479 · 10th to 90th $646 to $3,090Professionalmedian $468 · 10th to 90th $331 to $871
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 $489.78 Median $630.96 Typical High $4,897.79 | Facility | None | $489.78 | $630.96 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $269.15 Median $331.13 Typical High $501.19 | Professional | None | $269.15 | $331.13 | $501.19 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,479.11 Median $1,479.11 Typical High $2,570.40 | Facility | None | $1,479.11 | $1,479.11 | $2,570.40 |
BCBS Michigan Setting Professional Modifier None Typical Low $363.08 Median $616.60 Typical High $870.96 | Professional | None | $363.08 | $616.60 | $870.96 |
Cigna Setting Facility Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Facility | None | $407.38 | $407.38 | $407.38 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $426.58 Typical High $912.01 | Professional | None | $281.84 | $426.58 | $912.01 |
Health Alliance Plan Setting Facility Modifier None Typical Low $630.96 Median $1,071.52 Typical High $4,897.79 | Facility | None | $630.96 | $1,071.52 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $295.12 Median $436.52 Typical High $512.86 | Professional | None | $295.12 | $436.52 | $512.86 |
Priority Health Setting Facility Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Facility | None | $407.38 | $407.38 | $407.38 |
Priority Health Setting Professional Modifier None Typical Low $281.84 Median $426.58 Typical High $707.95 | Professional | None | $281.84 | $426.58 | $707.95 |
United Setting Facility Modifier None Typical Low $602.56 Median $1,230.27 Typical High $5,011.87 | Facility | None | $602.56 | $1,230.27 | $5,011.87 |
United Setting Professional Modifier None Typical Low $363.08 Median $389.05 Typical High $467.74 | Professional | None | $363.08 | $389.05 | $467.74 |
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 $239.88 Median $251.19 Typical High $251.19 | Professional | 52 · Reduced service | $239.88 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $97.72 Median $100.00 Typical High $100.00 | Professional | 53 · Discontinued | $97.72 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $363.08 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $363.08 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $72.44 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $72.44 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $48.98 Median $50.12 Typical High $50.12 | Professional | 56 · Pre-op care only | $48.98 | $50.12 | $50.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $338.84 Median $346.74 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $338.84 | $346.74 | $346.74 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $234.42 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $234.42 | $245.47 | $245.47 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $97.72 Typical High $97.72 | Professional | 53 · Discontinued | $93.33 | $97.72 | $97.72 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $346.74 Median $363.08 Typical High $363.08 | Professional | 54 · Surgery only | $346.74 | $363.08 | $363.08 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $72.44 Typical High $72.44 | Professional | 55 · Aftercare only | $70.79 | $72.44 | $72.44 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $48.98 Typical High $48.98 | Professional | 56 · Pre-op care only | $46.77 | $48.98 | $48.98 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $323.59 Median $338.84 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $323.59 | $338.84 | $338.84 |
Where Michigan sits
The same service costs 4.0 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 $4,866MT $1,221
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.