How much rates vary
Facilitymedian $245 · 10th to 90th $107 to $676Professionalmedian $275 · 10th to 90th $148 to $437
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 $177.83 Median $407.38 Typical High $4,897.79 | Facility | None | $177.83 | $407.38 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $177.83 Median $251.19 Typical High $436.52 | Professional | None | $177.83 | $251.19 | $436.52 |
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 $245.47 Median $245.47 Typical High $426.58 | Facility | None | $245.47 | $245.47 | $426.58 |
BCBS Michigan Setting Professional Modifier None Typical Low $38.02 Median $239.88 Typical High $616.60 | Professional | None | $38.02 | $239.88 | $616.60 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $251.19 Typical High $489.78 | Professional | None | $114.82 | $251.19 | $489.78 |
Health Alliance Plan Setting Facility Modifier None Typical Low $79.43 Median $407.38 Typical High $3,388.44 | Facility | None | $79.43 | $407.38 | $3,388.44 |
Health Alliance Plan Setting Professional Modifier None Typical Low $186.21 Median $331.13 Typical High $446.68 | Professional | None | $186.21 | $331.13 | $446.68 |
Priority Health Setting Professional Modifier None Typical Low $107.15 Median $229.09 Typical High $363.08 | Professional | None | $107.15 | $229.09 | $363.08 |
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 $147.91 Median $257.04 Typical High $331.13 | Professional | None | $147.91 | $257.04 | $331.13 |
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 $89.13 Median $138.04 Typical High $208.93 | Professional | 52 · Reduced service | $89.13 | $138.04 | $208.93 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $54.95 Typical High $83.18 | Professional | 53 · Discontinued | $35.48 | $54.95 | $83.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $208.93 Typical High $309.03 | Professional | 54 · Surgery only | $134.90 | $208.93 | $309.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $41.69 Typical High $63.10 | Professional | 55 · Aftercare only | $26.92 | $41.69 | $63.10 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $27.54 Typical High $41.69 | Professional | 56 · Pre-op care only | $17.78 | $27.54 | $41.69 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $194.98 Typical High $288.40 | Professional | 78 · Unplanned return to OR | $125.89 | $194.98 | $288.40 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $89.13 Median $112.20 Typical High $223.87 | Professional | 52 · Reduced service | $89.13 | $112.20 | $223.87 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $44.67 Typical High $89.13 | Professional | 53 · Discontinued | $35.48 | $44.67 | $89.13 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $190.55 Typical High $331.13 | Professional | 54 · Surgery only | $134.90 | $190.55 | $331.13 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $33.88 Typical High $66.07 | Professional | 55 · Aftercare only | $26.92 | $33.88 | $66.07 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $22.39 Typical High $44.67 | Professional | 56 · Pre-op care only | $17.78 | $22.39 | $44.67 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $158.49 Typical High $309.03 | Professional | 78 · Unplanned return to OR | $125.89 | $158.49 | $309.03 |
Where Michigan sits
The same service costs 3.6 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· 25th of 51
$269
WI $603KY $166
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.