How much rates vary
Facilitymedian $1,479 · 10th to 90th $631 to $3,162Professionalmedian $204 · 10th to 90th $36 to $282
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 $177.83 Median $2,884.03 Typical High $4,897.79 | Facility | None | $177.83 | $2,884.03 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $181.97 Typical High $190.55 | Professional | None | $169.82 | $181.97 | $190.55 |
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 $30.90 Median $194.98 Typical High $275.42 | Professional | None | $30.90 | $194.98 | $275.42 |
CareSource Setting Facility Modifier None Typical Low $1,348.96 Median $1,348.96 Typical High $1,348.96 | Facility | None | $1,348.96 | $1,348.96 | $1,348.96 |
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 $97.72 Median $204.17 Typical High $436.52 | Professional | None | $97.72 | $204.17 | $436.52 |
Health Alliance Plan Setting Facility Modifier None Typical Low $524.81 Median $1,202.26 Typical High $4,897.79 | Facility | None | $524.81 | $1,202.26 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $173.78 Median $213.80 Typical High $281.84 | Professional | None | $173.78 | $213.80 | $281.84 |
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 $97.72 Median $158.49 Typical High $776.25 | Professional | None | $97.72 | $158.49 | $776.25 |
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 $154.88 Median $208.93 Typical High $269.15 | Professional | None | $154.88 | $208.93 | $269.15 |
13 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 $89.13 Median $91.20 Typical High $91.20 | Professional | 52 · Reduced service | $89.13 | $91.20 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $36.31 Typical High $36.31 | Professional | 53 · Discontinued | $35.48 | $36.31 | $36.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $138.04 Typical High $138.04 | Professional | 54 · Surgery only | $131.83 | $138.04 | $138.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $27.54 Typical High $27.54 | Professional | 55 · Aftercare only | $26.30 | $27.54 | $27.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $18.20 Typical High $18.20 | Professional | 56 · Pre-op care only | $17.78 | $18.20 | $18.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $123.03 Median $128.82 Typical High $128.82 | Professional | 78 · Unplanned return to OR | $123.03 | $128.82 | $128.82 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $288.40 Median $288.40 Typical High $288.40 | Professional | 50 · Both sides | $288.40 | $288.40 | $288.40 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $87.10 Median $89.13 Typical High $89.13 | Professional | 52 · Reduced service | $87.10 | $89.13 | $89.13 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $36.31 Typical High $36.31 | Professional | 53 · Discontinued | $34.67 | $36.31 | $36.31 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $134.90 Typical High $134.90 | Professional | 54 · Surgery only | $128.82 | $134.90 | $134.90 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $26.92 Typical High $26.92 | Professional | 55 · Aftercare only | $26.30 | $26.92 | $26.92 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $18.20 Typical High $18.20 | Professional | 56 · Pre-op care only | $17.38 | $18.20 | $18.20 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $125.89 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $120.23 | $125.89 | $125.89 |
Where Michigan sits
The same service costs 11.0 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 $4,556MT $413
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.