How much rates vary
Facilitymedian $81 · 10th to 90th $52 to $708Professionalmedian $68 · 10th to 90th $45 to $81
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 $66.07 Median $2,041.74 Typical High $4,897.79 | Facility | None | $66.07 | $2,041.74 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $53.70 Median $67.61 Typical High $70.79 | Professional | None | $53.70 | $67.61 | $70.79 |
BCBS Michigan Setting Facility Modifier None Typical Low $52.48 Median $52.48 Typical High $91.20 | Facility | None | $52.48 | $52.48 | $91.20 |
BCBS Michigan Setting Professional Modifier None Typical Low $14.13 Median $70.79 Typical High $70.79 | Professional | None | $14.13 | $70.79 | $70.79 |
Cigna Setting Professional Modifier None Typical Low $38.02 Median $61.66 Typical High $83.18 | Professional | None | $38.02 | $61.66 | $83.18 |
Health Alliance Plan Setting Facility Modifier None Typical Low $67.61 Median $154.88 Typical High $4,897.79 | Facility | None | $67.61 | $154.88 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $52.48 Median $64.57 Typical High $81.28 | Professional | None | $52.48 | $64.57 | $81.28 |
Priority Health Setting Professional Modifier None Typical Low $35.48 Median $57.54 Typical High $83.18 | Professional | None | $35.48 | $57.54 | $83.18 |
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 $58.88 Median $72.44 Typical High $91.20 | Professional | None | $58.88 | $72.44 | $91.20 |
10 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 $26.92 Median $33.88 Typical High $35.48 | Professional | 52 · Reduced service | $26.92 | $33.88 | $35.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.72 Median $13.49 Typical High $14.13 | Professional | 53 · Discontinued | $10.72 | $13.49 | $14.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $40.74 Median $51.29 Typical High $52.48 | Professional | 54 · Surgery only | $40.74 | $51.29 | $52.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.13 Median $10.23 Typical High $10.47 | Professional | 55 · Aftercare only | $8.13 | $10.23 | $10.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.37 Median $6.76 Typical High $7.08 | Professional | 56 · Pre-op care only | $5.37 | $6.76 | $7.08 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $32.36 Median $33.11 Typical High $33.11 | Professional | 52 · Reduced service | $32.36 | $33.11 | $33.11 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $12.88 Median $13.49 Typical High $13.49 | Professional | 53 · Discontinued | $12.88 | $13.49 | $13.49 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $47.86 Median $50.12 Typical High $50.12 | Professional | 54 · Surgery only | $47.86 | $50.12 | $50.12 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $10.00 Typical High $10.00 | Professional | 55 · Aftercare only | $9.77 | $10.00 | $10.00 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $6.46 Median $6.76 Typical High $6.76 | Professional | 56 · Pre-op care only | $6.46 | $6.76 | $6.76 |
Where Michigan sits
The same service costs 6.5 times more in Tennessee than in New York. 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· 38th of 51
$67.61
TN $316NY $48.98
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.