How much rates vary
Facilitymedian $1,738 · 10th to 90th $224 to $3,311Professionalmedian $224 · 10th to 90th $148 to $288
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 $213.80 Median $269.15 Typical High $4,897.79 | Facility | None | $213.80 | $269.15 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $223.87 Typical High $281.84 | Professional | None | $194.98 | $223.87 | $281.84 |
Ambetter Setting Professional Modifier None Typical Low $147.91 Median $147.91 Typical High $147.91 | Professional | None | $147.91 | $147.91 | $147.91 |
BCBS Michigan Setting Facility Modifier None Typical Low $1,737.80 Median $1,737.80 Typical High $3,019.95 | Facility | None | $1,737.80 | $1,737.80 | $3,019.95 |
BCBS Michigan Setting Professional Modifier None Typical Low $38.02 Median $181.97 Typical High $281.84 | Professional | None | $38.02 | $181.97 | $281.84 |
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 $144.54 Median $186.21 Typical High $269.15 | Professional | None | $144.54 | $186.21 | $269.15 |
Health Alliance Plan Setting Facility Modifier None Typical Low $194.98 Median $588.84 Typical High $6,918.31 | Facility | None | $194.98 | $588.84 | $6,918.31 |
Health Alliance Plan Setting Professional Modifier None Typical Low $208.93 Median $263.03 Typical High $302.00 | Professional | None | $208.93 | $263.03 | $302.00 |
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 $144.54 Median $186.21 Typical High $269.15 | Professional | None | $144.54 | $186.21 | $269.15 |
United Setting Facility Modifier None Typical Low $288.40 Median $426.58 Typical High $2,691.53 | Facility | None | $288.40 | $426.58 | $2,691.53 |
United Setting Professional Modifier None Typical Low $186.21 Median $229.09 Typical High $288.40 | Professional | None | $186.21 | $229.09 | $288.40 |
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 $107.15 Median $107.15 Typical High $134.90 | Professional | 52 · Reduced service | $107.15 | $107.15 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $42.66 Median $42.66 Typical High $53.70 | Professional | 53 · Discontinued | $42.66 | $42.66 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $162.18 Typical High $199.53 | Professional | 54 · Surgery only | $158.49 | $162.18 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $32.36 Typical High $39.81 | Professional | 55 · Aftercare only | $31.62 | $32.36 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.38 Median $21.38 Typical High $26.92 | Professional | 56 · Pre-op care only | $21.38 | $21.38 | $26.92 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $147.91 Median $151.36 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $147.91 | $151.36 | $186.21 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $104.71 Median $104.71 Typical High $131.83 | Professional | 52 · Reduced service | $104.71 | $104.71 | $131.83 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $41.69 Typical High $52.48 | Professional | 53 · Discontinued | $41.69 | $41.69 | $52.48 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $154.88 Typical High $199.53 | Professional | 54 · Surgery only | $154.88 | $154.88 | $199.53 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $30.90 Typical High $39.81 | Professional | 55 · Aftercare only | $30.90 | $30.90 | $39.81 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $20.89 Median $20.89 Typical High $26.30 | Professional | 56 · Pre-op care only | $20.89 | $20.89 | $26.30 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $144.54 Median $144.54 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $144.54 | $144.54 | $186.21 |
Where Michigan sits
The same service costs 3.9 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· 29th of 51
$229
AK $724KY $186
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.