How much rates vary
Facilitymedian $145 · 10th to 90th $91 to $955Professionalmedian $110 · 10th to 90th $63 to $145
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 $79.43 Median $128.82 Typical High $4,897.79 | Facility | None | $79.43 | $128.82 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $79.43 Median $104.71 Typical High $134.90 | Professional | None | $79.43 | $104.71 | $134.90 |
Ambetter Setting Professional Modifier None Typical Low $63.10 Median $104.71 Typical High $131.83 | Professional | None | $63.10 | $104.71 | $131.83 |
BCBS Michigan Setting Facility Modifier None Typical Low $107.15 Median $109.65 Typical High $186.21 | Facility | None | $107.15 | $109.65 | $186.21 |
BCBS Michigan Setting Professional Modifier None Typical Low $13.49 Median $70.79 Typical High $134.90 | Professional | None | $13.49 | $70.79 | $134.90 |
CareSource Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $138.04 | Professional | None | $138.04 | $138.04 | $138.04 |
Cigna Setting Professional Modifier None Typical Low $48.98 Median $81.28 Typical High $117.49 | Professional | None | $48.98 | $81.28 | $117.49 |
Health Alliance Plan Setting Facility Modifier None Typical Low $83.18 Median $263.03 Typical High $2,511.89 | Facility | None | $83.18 | $263.03 | $2,511.89 |
Health Alliance Plan Setting Professional Modifier None Typical Low $77.62 Median $125.89 Typical High $169.82 | Professional | None | $77.62 | $125.89 | $169.82 |
Priority Health Setting Professional Modifier None Typical Low $57.54 Median $79.43 Typical High $117.49 | Professional | None | $57.54 | $79.43 | $117.49 |
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 $70.79 Median $104.71 Typical High $138.04 | Professional | None | $70.79 | $104.71 | $138.04 |
15 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 $39.81 Median $47.86 Typical High $64.57 | Professional | 52 · Reduced service | $39.81 | $47.86 | $64.57 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.85 Median $19.05 Typical High $25.70 | Professional | 53 · Discontinued | $15.85 | $19.05 | $25.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $60.26 Median $72.44 Typical High $97.72 | Professional | 54 · Surgery only | $60.26 | $72.44 | $97.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.02 Median $14.79 Typical High $19.50 | Professional | 55 · Aftercare only | $12.02 | $14.79 | $19.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.94 Median $9.77 Typical High $12.88 | Professional | 56 · Pre-op care only | $7.94 | $9.77 | $12.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $56.23 Median $67.61 Typical High $91.20 | Professional | 78 · Unplanned return to OR | $56.23 | $67.61 | $91.20 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $63.10 Median $89.13 Typical High $104.71 | Professional | 59 · Distinct service | $63.10 | $89.13 | $104.71 |
Ambetter Setting Professional Modifier 79 · Unrelated procedure after surgery Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | 79 · Unrelated procedure after surgery | $109.65 | $109.65 | $109.65 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $38.90 Median $47.86 Typical High $64.57 | Professional | 52 · Reduced service | $38.90 | $47.86 | $64.57 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $15.49 Median $19.05 Typical High $25.70 | Professional | 53 · Discontinued | $15.49 | $19.05 | $25.70 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $70.79 Typical High $97.72 | Professional | 54 · Surgery only | $57.54 | $70.79 | $97.72 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $14.13 Typical High $19.50 | Professional | 55 · Aftercare only | $11.48 | $14.13 | $19.50 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $9.55 Typical High $12.88 | Professional | 56 · Pre-op care only | $7.76 | $9.55 | $12.88 |
Health Alliance Plan Setting Professional Modifier 59 · Distinct service Typical Low $50.12 Median $83.18 Typical High $169.82 | Professional | 59 · Distinct service | $50.12 | $83.18 | $169.82 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $53.70 Median $66.07 Typical High $91.20 | Professional | 78 · Unplanned return to OR | $53.70 | $66.07 | $91.20 |
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· 30th of 51
$110
AK $309KY $79.43
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.