How much rates vary
Facilitymedian $112 · 10th to 90th $81 to $617Professionalmedian $55 · 10th to 90th $26 to $98
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 $26.92 Median $93.33 Typical High $4,897.79 | Facility | None | $26.92 | $93.33 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $26.30 Median $48.98 Typical High $97.72 | Professional | None | $26.30 | $48.98 | $97.72 |
Ambetter Setting Professional Modifier None Typical Low $19.50 Median $19.50 Typical High $19.50 | Professional | None | $19.50 | $19.50 | $19.50 |
BCBS Michigan Setting Facility Modifier None Typical Low $81.28 Median $83.18 Typical High $141.25 | Facility | None | $81.28 | $83.18 | $141.25 |
BCBS Michigan Setting Professional Modifier None Typical Low $19.05 Median $30.20 Typical High $134.90 | Professional | None | $19.05 | $30.20 | $134.90 |
CareSource Setting Facility Modifier None Typical Low $79.43 Median $79.43 Typical High $79.43 | Facility | None | $79.43 | $79.43 | $79.43 |
CareSource Setting Professional Modifier None Typical Low $100.00 Median $100.00 Typical High $100.00 | Professional | None | $100.00 | $100.00 | $100.00 |
Cigna Setting Professional Modifier None Typical Low $18.62 Median $50.12 Typical High $83.18 | Professional | None | $18.62 | $50.12 | $83.18 |
Health Alliance Plan Setting Facility Modifier None Typical Low $57.54 Median $147.91 Typical High $2,884.03 | Facility | None | $57.54 | $147.91 | $2,884.03 |
Health Alliance Plan Setting Professional Modifier None Typical Low $26.30 Median $70.79 Typical High $97.72 | Professional | None | $26.30 | $70.79 | $97.72 |
Priority Health Setting Professional Modifier None Typical Low $18.62 Median $33.88 Typical High $83.18 | Professional | None | $18.62 | $33.88 | $83.18 |
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 $25.70 Median $56.23 Typical High $87.10 | Professional | None | $25.70 | $56.23 | $87.10 |
11 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 $12.88 Median $34.67 Typical High $46.77 | Professional | 52 · Reduced service | $12.88 | $34.67 | $46.77 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.25 Median $13.80 Typical High $18.62 | Professional | 53 · Discontinued | $5.25 | $13.80 | $18.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $19.50 Median $51.29 Typical High $69.18 | Professional | 54 · Surgery only | $19.50 | $51.29 | $69.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.89 Median $10.23 Typical High $13.80 | Professional | 55 · Aftercare only | $3.89 | $10.23 | $13.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.63 Median $6.92 Typical High $9.33 | Professional | 56 · Pre-op care only | $2.63 | $6.92 | $9.33 |
Ambetter Setting Professional Modifier Q8 · Foot care: two class B findings Typical Low $79.43 Median $79.43 Typical High $79.43 | Professional | Q8 · Foot care: two class B findings | $79.43 | $79.43 | $79.43 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $13.18 Median $17.38 Typical High $46.77 | Professional | 52 · Reduced service | $13.18 | $17.38 | $46.77 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $5.25 Median $7.08 Typical High $18.62 | Professional | 53 · Discontinued | $5.25 | $7.08 | $18.62 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $19.50 Median $26.30 Typical High $70.79 | Professional | 54 · Surgery only | $19.50 | $26.30 | $70.79 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $3.89 Median $5.25 Typical High $14.13 | Professional | 55 · Aftercare only | $3.89 | $5.25 | $14.13 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $2.63 Median $3.47 Typical High $9.33 | Professional | 56 · Pre-op care only | $2.63 | $3.47 | $9.33 |
Where Michigan sits
The same service costs 3.4 times more in Wisconsin 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· 37th of 51
$60.26
WI $123KY $36.31
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.