How much rates vary
Facilitymedian $427 · 10th to 90th $123 to $891Professionalmedian $162 · 10th to 90th $98 to $234
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 $123.03 Median $173.78 Typical High $2,041.74 | Facility | None | $123.03 | $173.78 | $2,041.74 |
Aetna Setting Professional Modifier None Typical Low $123.03 Median $151.36 Typical High $181.97 | Professional | None | $123.03 | $151.36 | $181.97 |
Ambetter Setting Professional Modifier None Typical Low $147.91 Median $173.78 Typical High $173.78 | Professional | None | $147.91 | $173.78 | $173.78 |
BCBS Michigan Setting Facility Modifier None Typical Low $426.58 Median $436.52 Typical High $741.31 | Facility | None | $426.58 | $436.52 | $741.31 |
BCBS Michigan Setting Professional Modifier None Typical Low $31.62 Median $169.82 Typical High $257.04 | Professional | None | $31.62 | $169.82 | $257.04 |
CareSource Setting Professional Modifier None Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | None | $186.21 | $186.21 | $186.21 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $125.89 Typical High $199.53 | Professional | None | $79.43 | $125.89 | $199.53 |
Health Alliance Plan Setting Facility Modifier None Typical Low $131.83 Median $338.84 Typical High $2,041.74 | Facility | None | $131.83 | $338.84 | $2,041.74 |
Health Alliance Plan Setting Professional Modifier None Typical Low $123.03 Median $173.78 Typical High $208.93 | Professional | None | $123.03 | $173.78 | $208.93 |
Priority Health Setting Professional Modifier None Typical Low $93.33 Median $131.83 Typical High $199.53 | Professional | None | $93.33 | $131.83 | $199.53 |
United Setting Facility Modifier None Typical Low $91.20 Median $177.83 Typical High $1,202.26 | Facility | None | $91.20 | $177.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $100.00 Median $141.25 Typical High $186.21 | Professional | None | $100.00 | $141.25 | $186.21 |
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 $61.66 Median $64.57 Typical High $87.10 | Professional | 52 · Reduced service | $61.66 | $64.57 | $87.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $25.70 Typical High $34.67 | Professional | 53 · Discontinued | $25.12 | $25.70 | $34.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $97.72 Typical High $131.83 | Professional | 54 · Surgery only | $93.33 | $97.72 | $131.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $19.50 Typical High $26.30 | Professional | 55 · Aftercare only | $18.62 | $19.50 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $12.88 Typical High $17.38 | Professional | 56 · Pre-op care only | $12.30 | $12.88 | $17.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $87.10 Median $91.20 Typical High $123.03 | Professional | 78 · Unplanned return to OR | $87.10 | $91.20 | $123.03 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $60.26 Median $64.57 Typical High $87.10 | Professional | 52 · Reduced service | $60.26 | $64.57 | $87.10 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $25.12 Typical High $34.67 | Professional | 53 · Discontinued | $24.55 | $25.12 | $34.67 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $109.65 Typical High $128.82 | Professional | 54 · Surgery only | $91.20 | $109.65 | $128.82 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $19.05 Typical High $26.30 | Professional | 55 · Aftercare only | $18.20 | $19.05 | $26.30 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $12.59 Typical High $17.38 | Professional | 56 · Pre-op care only | $12.30 | $12.59 | $17.38 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $87.10 Typical High $123.03 | Professional | 78 · Unplanned return to OR | $85.11 | $87.10 | $123.03 |
Where Michigan sits
The same service costs 4.1 times more in Alaska than in Kentucky. 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.
Michigan· 21st of 51
$170
AK $447KY $110
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.