How much rates vary
Facilitymedian $3,311 · 10th to 90th $646 to $6,166Professionalmedian $407 · 10th to 90th $263 to $550
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 $380.19 Median $426.58 Typical High $4,897.79 | Facility | None | $380.19 | $426.58 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $363.08 Median $398.11 Typical High $426.58 | Professional | None | $363.08 | $398.11 | $426.58 |
Ambetter Setting Professional Modifier None Typical Low $295.12 Median $295.12 Typical High $295.12 | Professional | None | $295.12 | $295.12 | $295.12 |
BCBS Michigan Setting Facility Modifier None Typical Low $3,311.31 Median $3,388.44 Typical High $5,888.44 | Facility | None | $3,311.31 | $3,388.44 | $5,888.44 |
BCBS Michigan Setting Professional Modifier None Typical Low $85.11 Median $426.58 Typical High $426.58 | Professional | None | $85.11 | $426.58 | $426.58 |
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 $239.88 Median $436.52 Typical High $1,096.48 | Professional | None | $239.88 | $436.52 | $1,096.48 |
Health Alliance Plan Setting Facility Modifier None Typical Low $416.87 Median $2,187.76 Typical High $5,754.40 | Facility | None | $416.87 | $2,187.76 | $5,754.40 |
Health Alliance Plan Setting Professional Modifier None Typical Low $371.54 Median $407.38 Typical High $562.34 | Professional | None | $371.54 | $407.38 | $562.34 |
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 $239.88 Median $426.58 Typical High $977.24 | Professional | None | $239.88 | $426.58 | $977.24 |
United Setting Facility Modifier None Typical Low $660.69 Median $1,548.82 Typical High $6,918.31 | Facility | None | $660.69 | $1,548.82 | $6,918.31 |
United Setting Professional Modifier None Typical Low $371.54 Median $489.78 Typical High $588.84 | Professional | None | $371.54 | $489.78 | $588.84 |
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 $173.78 Median $199.53 Typical High $199.53 | Professional | 52 · Reduced service | $173.78 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $81.28 Typical High $81.28 | Professional | 53 · Discontinued | $69.18 | $81.28 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $263.03 Median $302.00 Typical High $302.00 | Professional | 54 · Surgery only | $263.03 | $302.00 | $302.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $52.48 Median $60.26 Typical High $60.26 | Professional | 55 · Aftercare only | $52.48 | $60.26 | $60.26 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $39.81 Typical High $39.81 | Professional | 56 · Pre-op care only | $34.67 | $39.81 | $39.81 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $186.21 Median $194.98 Typical High $194.98 | Professional | 52 · Reduced service | $186.21 | $194.98 | $194.98 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $74.13 Median $77.62 Typical High $77.62 | Professional | 53 · Discontinued | $74.13 | $77.62 | $77.62 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $281.84 Median $288.40 Typical High $288.40 | Professional | 54 · Surgery only | $281.84 | $288.40 | $288.40 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $56.23 Median $57.54 Typical High $57.54 | Professional | 55 · Aftercare only | $56.23 | $57.54 | $57.54 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $37.15 Median $38.90 Typical High $38.90 | Professional | 56 · Pre-op care only | $37.15 | $38.90 | $38.90 |
Where Michigan sits
The same service costs 10.0 times more in Oklahoma 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· 44th of 51
$427
OK $2,884NY $288
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.