How much rates vary
Facilitymedian $427 · 10th to 90th $112 to $1,259Professionalmedian $170 · 10th to 90th $107 to $269
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 $109.65 Median $169.82 Typical High $2,884.03 | Facility | None | $109.65 | $169.82 | $2,884.03 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $165.96 Typical High $199.53 | Professional | None | $109.65 | $165.96 | $199.53 |
Ambetter Setting Professional Modifier None Typical Low $125.89 Median $147.91 Typical High $147.91 | Professional | None | $125.89 | $147.91 | $147.91 |
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 $67.61 Median $162.18 Typical High $194.98 | Professional | None | $67.61 | $162.18 | $194.98 |
CareSource Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $199.53 | Professional | None | $199.53 | $199.53 | $199.53 |
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 $91.20 Median $154.88 Typical High $239.88 | Professional | None | $91.20 | $154.88 | $239.88 |
Health Alliance Plan Setting Facility Modifier None Typical Low $112.20 Median $186.21 Typical High $4,897.79 | Facility | None | $112.20 | $186.21 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $107.15 Median $199.53 Typical High $281.84 | Professional | None | $107.15 | $199.53 | $281.84 |
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 $91.20 Median $169.82 Typical High $239.88 | Professional | None | $91.20 | $169.82 | $239.88 |
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 $125.89 Median $190.55 Typical High $257.04 | Professional | None | $125.89 | $190.55 | $257.04 |
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 $54.95 Median $70.79 Typical High $85.11 | Professional | 52 · Reduced service | $54.95 | $70.79 | $85.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $28.84 Typical High $33.88 | Professional | 53 · Discontinued | $21.88 | $28.84 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $107.15 Typical High $125.89 | Professional | 54 · Surgery only | $81.28 | $107.15 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $21.38 Typical High $25.12 | Professional | 55 · Aftercare only | $16.22 | $21.38 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $14.45 Typical High $16.98 | Professional | 56 · Pre-op care only | $10.96 | $14.45 | $16.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $75.86 Median $100.00 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $75.86 | $100.00 | $117.49 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $53.70 Median $57.54 Typical High $83.18 | Professional | 52 · Reduced service | $53.70 | $57.54 | $83.18 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $22.91 Typical High $33.88 | Professional | 53 · Discontinued | $21.38 | $22.91 | $33.88 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $107.15 Typical High $125.89 | Professional | 54 · Surgery only | $81.28 | $107.15 | $125.89 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $17.38 Typical High $25.12 | Professional | 55 · Aftercare only | $16.22 | $17.38 | $25.12 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $10.72 Median $11.48 Typical High $16.98 | Professional | 56 · Pre-op care only | $10.72 | $11.48 | $16.98 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $75.86 Median $81.28 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $75.86 | $81.28 | $117.49 |
Where Michigan sits
The same service costs 3.2 times more in Alaska than in Texas. 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· 36th of 51
$170
AK $427TX $132
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.