How much rates vary
Facilitymedian $245 · 10th to 90th $105 to $537Professionalmedian $129 · 10th to 90th $91 to $174
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 $112.20 Median $144.54 Typical High $4,897.79 | Facility | None | $112.20 | $144.54 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $120.23 Typical High $154.88 | Professional | None | $109.65 | $120.23 | $154.88 |
BCBS Michigan Setting Facility Modifier None Typical Low $245.47 Median $251.19 Typical High $426.58 | Facility | None | $245.47 | $251.19 | $426.58 |
BCBS Michigan Setting Professional Modifier None Typical Low $25.70 Median $128.82 Typical High $199.53 | Professional | None | $25.70 | $128.82 | $199.53 |
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 $79.43 Median $112.20 Typical High $177.83 | Professional | None | $79.43 | $112.20 | $177.83 |
Health Alliance Plan Setting Facility Modifier None Typical Low $95.50 Median $114.82 Typical High $316.23 | Facility | None | $95.50 | $114.82 | $316.23 |
Health Alliance Plan Setting Professional Modifier None Typical Low $107.15 Median $134.90 Typical High $162.18 | Professional | None | $107.15 | $134.90 | $162.18 |
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 $79.43 Median $109.65 Typical High $162.18 | Professional | None | $79.43 | $109.65 | $162.18 |
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 $97.72 Median $125.89 Typical High $165.96 | Professional | None | $97.72 | $125.89 | $165.96 |
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 $56.23 Median $56.23 Typical High $74.13 | Professional | 52 · Reduced service | $56.23 | $56.23 | $74.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.39 Median $22.39 Typical High $29.51 | Professional | 53 · Discontinued | $22.39 | $22.39 | $29.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $83.18 Typical High $109.65 | Professional | 54 · Surgery only | $83.18 | $83.18 | $109.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $16.98 Typical High $21.88 | Professional | 55 · Aftercare only | $16.60 | $16.98 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.22 Median $11.22 Typical High $14.79 | Professional | 56 · Pre-op care only | $11.22 | $11.22 | $14.79 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $77.62 Median $77.62 Typical High $102.33 | Professional | 78 · Unplanned return to OR | $77.62 | $77.62 | $102.33 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $53.70 Median $54.95 Typical High $72.44 | Professional | 52 · Reduced service | $53.70 | $54.95 | $72.44 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $21.88 Typical High $28.84 | Professional | 53 · Discontinued | $21.88 | $21.88 | $28.84 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $83.18 Typical High $107.15 | Professional | 54 · Surgery only | $81.28 | $83.18 | $107.15 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $16.60 Typical High $21.88 | Professional | 55 · Aftercare only | $16.22 | $16.60 | $21.88 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $10.96 Typical High $14.45 | Professional | 56 · Pre-op care only | $10.96 | $10.96 | $14.45 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $75.86 Median $77.62 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $75.86 | $77.62 | $100.00 |
Where Michigan sits
The same service costs 3.3 times more in Alaska than in Pennsylvania. 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· 32nd of 51
$129
AK $355PA $107
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.