How much rates vary
Facilitymedian $646 · 10th to 90th $288 to $2,042Professionalmedian $263 · 10th to 90th $141 to $389
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 $245.47 Median $354.81 Typical High $4,897.79 | Facility | None | $245.47 | $354.81 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $245.47 Median $275.42 Typical High $354.81 | Professional | None | $245.47 | $275.42 | $354.81 |
Ambetter Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $323.59 | Professional | None | $323.59 | $323.59 | $323.59 |
BCBS Michigan Setting Facility Modifier None Typical Low $645.65 Median $660.69 Typical High $1,148.15 | Facility | None | $645.65 | $660.69 | $1,148.15 |
BCBS Michigan Setting Professional Modifier None Typical Low $42.66 Median $223.87 Typical High $398.11 | Professional | None | $42.66 | $223.87 | $398.11 |
CareSource Setting Professional Modifier None Typical Low $257.04 Median $354.81 Typical High $416.87 | Professional | None | $257.04 | $354.81 | $416.87 |
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 $169.82 Median $263.03 Typical High $489.78 | Professional | None | $169.82 | $263.03 | $489.78 |
Health Alliance Plan Setting Facility Modifier None Typical Low $239.88 Median $588.84 Typical High $3,467.37 | Facility | None | $239.88 | $588.84 | $3,467.37 |
Health Alliance Plan Setting Professional Modifier None Typical Low $245.47 Median $309.03 Typical High $371.54 | Professional | None | $245.47 | $309.03 | $371.54 |
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 $162.18 Median $251.19 Typical High $426.58 | Professional | None | $162.18 | $251.19 | $426.58 |
United Setting Facility Modifier None Typical Low $288.40 Median $426.58 Typical High $2,089.30 | Facility | None | $288.40 | $426.58 | $2,089.30 |
United Setting Professional Modifier None Typical Low $229.09 Median $288.40 Typical High $389.05 | Professional | None | $229.09 | $288.40 | $389.05 |
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 $123.03 Median $131.83 Typical High $177.83 | Professional | 52 · Reduced service | $123.03 | $131.83 | $177.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $48.98 Median $52.48 Typical High $70.79 | Professional | 53 · Discontinued | $48.98 | $52.48 | $70.79 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $181.97 Median $199.53 Typical High $263.03 | Professional | 54 · Surgery only | $181.97 | $199.53 | $263.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $37.15 Median $39.81 Typical High $52.48 | Professional | 55 · Aftercare only | $37.15 | $39.81 | $52.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $24.55 Median $26.30 Typical High $35.48 | Professional | 56 · Pre-op care only | $24.55 | $26.30 | $35.48 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $169.82 Median $186.21 Typical High $245.47 | Professional | 78 · Unplanned return to OR | $169.82 | $186.21 | $245.47 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $123.03 Median $131.83 Typical High $177.83 | Professional | 52 · Reduced service | $123.03 | $131.83 | $177.83 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $48.98 Median $52.48 Typical High $70.79 | Professional | 53 · Discontinued | $48.98 | $52.48 | $70.79 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $181.97 Median $194.98 Typical High $263.03 | Professional | 54 · Surgery only | $181.97 | $194.98 | $263.03 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $36.31 Median $38.90 Typical High $53.70 | Professional | 55 · Aftercare only | $36.31 | $38.90 | $53.70 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $24.55 Median $26.30 Typical High $35.48 | Professional | 56 · Pre-op care only | $24.55 | $26.30 | $35.48 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $169.82 Median $181.97 Typical High $245.47 | Professional | 78 · Unplanned return to OR | $169.82 | $181.97 | $245.47 |
Where Michigan sits
The same service costs 3.8 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· 35th of 51
$263
AK $776KY $204
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.