How much rates vary
Facilitymedian $3,020 · 10th to 90th $490 to $5,012Professionalmedian $282 · 10th to 90th $200 to $363
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 $257.04 Median $338.84 Typical High $5,754.40 | Facility | None | $257.04 | $338.84 | $5,754.40 |
Aetna Setting Professional Modifier None Typical Low $239.88 Median $281.84 Typical High $346.74 | Professional | None | $239.88 | $281.84 | $346.74 |
Ambetter Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $199.53 | Professional | None | $199.53 | $199.53 | $199.53 |
BCBS Michigan Setting Facility Modifier None Typical Low $3,019.95 Median $3,019.95 Typical High $5,248.07 | Facility | None | $3,019.95 | $3,019.95 | $5,248.07 |
BCBS Michigan Setting Professional Modifier None Typical Low $173.78 Median $295.12 Typical High $446.68 | Professional | None | $173.78 | $295.12 | $446.68 |
Cigna Setting Facility Modifier None Typical Low $630.96 Median $630.96 Typical High $630.96 | Facility | None | $630.96 | $630.96 | $630.96 |
Cigna Setting Professional Modifier None Typical Low $194.98 Median $269.15 Typical High $467.74 | Professional | None | $194.98 | $269.15 | $467.74 |
Health Alliance Plan Setting Facility Modifier None Typical Low $338.84 Median $1,230.27 Typical High $4,897.79 | Facility | None | $338.84 | $1,230.27 | $4,897.79 |
Health Alliance Plan Setting Professional Modifier None Typical Low $229.09 Median $288.40 Typical High $363.08 | Professional | None | $229.09 | $288.40 | $363.08 |
Priority Health Setting Facility Modifier None Typical Low $630.96 Median $630.96 Typical High $630.96 | Facility | None | $630.96 | $630.96 | $630.96 |
Priority Health Setting Professional Modifier None Typical Low $194.98 Median $257.04 Typical High $416.87 | Professional | None | $194.98 | $257.04 | $416.87 |
United Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $3,311.31 | Facility | None | $426.58 | $602.56 | $3,311.31 |
United Setting Professional Modifier None Typical Low $234.42 Median $275.42 Typical High $363.08 | Professional | None | $234.42 | $275.42 | $363.08 |
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 $128.82 Median $134.90 Typical High $173.78 | Professional | 52 · Reduced service | $128.82 | $134.90 | $173.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $51.29 Median $53.70 Typical High $69.18 | Professional | 53 · Discontinued | $51.29 | $53.70 | $69.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $204.17 Typical High $257.04 | Professional | 54 · Surgery only | $190.55 | $204.17 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $40.74 Typical High $51.29 | Professional | 55 · Aftercare only | $38.02 | $40.74 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $26.92 Typical High $34.67 | Professional | 56 · Pre-op care only | $25.70 | $26.92 | $34.67 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $190.55 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $177.83 | $190.55 | $239.88 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $125.89 Median $131.83 Typical High $169.82 | Professional | 52 · Reduced service | $125.89 | $131.83 | $169.82 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $50.12 Median $52.48 Typical High $67.61 | Professional | 53 · Discontinued | $50.12 | $52.48 | $67.61 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $194.98 Typical High $251.19 | Professional | 54 · Surgery only | $190.55 | $194.98 | $251.19 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $38.90 Typical High $51.29 | Professional | 55 · Aftercare only | $38.02 | $38.90 | $51.29 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $25.12 Median $26.30 Typical High $33.88 | Professional | 56 · Pre-op care only | $25.12 | $26.30 | $33.88 |
Health Alliance Plan Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $181.97 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $177.83 | $181.97 | $234.42 |
Where Michigan sits
The same service costs 4.7 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
$295
AK $1,000KY $214
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.