How much rates vary
Facilitymedian $178 · 10th to 90th $126 to $661Professionalmedian $166 · 10th to 90th $107 to $224
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 $131.83 Median $204.17 Typical High $4,897.79 | Facility | None | $131.83 | $204.17 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $128.82 Median $162.18 Typical High $213.80 | Professional | None | $128.82 | $162.18 | $213.80 |
Ambetter Setting Professional Modifier None Typical Low $95.50 Median $162.18 Typical High $245.47 | Professional | None | $95.50 | $162.18 | $245.47 |
BCBS Michigan Setting Facility Modifier None Typical Low $158.49 Median $162.18 Typical High $275.42 | Facility | None | $158.49 | $162.18 | $275.42 |
BCBS Michigan Setting Professional Modifier None Typical Low $22.39 Median $114.82 Typical High $213.80 | Professional | None | $22.39 | $114.82 | $213.80 |
CareSource Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $218.78 | Professional | None | $218.78 | $218.78 | $218.78 |
Cigna Setting Professional Modifier None Typical Low $91.20 Median $131.83 Typical High $186.21 | Professional | None | $91.20 | $131.83 | $186.21 |
Health Alliance Plan Setting Facility Modifier None Typical Low $162.18 Median $457.09 Typical High $4,897.79 | Facility | None | $162.18 | $457.09 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $128.82 Median $204.17 Typical High $234.42 | Professional | None | $128.82 | $204.17 | $234.42 |
Priority Health Setting Professional Modifier None Typical Low $91.20 Median $125.89 Typical High $186.21 | Professional | None | $91.20 | $125.89 | $186.21 |
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 $120.23 Median $169.82 Typical High $218.78 | Professional | None | $120.23 | $169.82 | $218.78 |
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 $64.57 Median $75.86 Typical High $102.33 | Professional | 52 · Reduced service | $64.57 | $75.86 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $30.20 Typical High $41.69 | Professional | 53 · Discontinued | $26.30 | $30.20 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $114.82 Typical High $154.88 | Professional | 54 · Surgery only | $97.72 | $114.82 | $154.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $22.91 Typical High $30.90 | Professional | 55 · Aftercare only | $19.50 | $22.91 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $15.14 Typical High $20.42 | Professional | 56 · Pre-op care only | $12.88 | $15.14 | $20.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $107.15 Typical High $144.54 | Professional | 78 · Unplanned return to OR | $91.20 | $107.15 | $144.54 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $64.57 Median $74.13 Typical High $102.33 | Professional | 52 · Reduced service | $64.57 | $74.13 | $102.33 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $30.20 Typical High $40.74 | Professional | 53 · Discontinued | $25.70 | $30.20 | $40.74 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $112.20 Typical High $154.88 | Professional | 54 · Surgery only | $95.50 | $112.20 | $154.88 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $22.39 Typical High $30.90 | Professional | 55 · Aftercare only | $19.50 | $22.39 | $30.90 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $14.79 Typical High $20.42 | Professional | 56 · Pre-op care only | $12.88 | $14.79 | $20.42 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $89.13 Median $104.71 Typical High $144.54 | Professional | 78 · Unplanned return to OR | $89.13 | $104.71 | $144.54 |
Where Michigan sits
The same service costs 3.4 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· 27th of 51
$170
AK $447KY $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.