How much rates vary
Facilitymedian $741 · 10th to 90th $95 to $2,239Professionalmedian $66 · 10th to 90th $38 to $120
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 $52.48 Median $91.20 Typical High $2,041.74 | Facility | None | $52.48 | $91.20 | $2,041.74 |
Aetna Setting Professional Modifier None Typical Low $37.15 Median $66.07 Typical High $95.50 | Professional | None | $37.15 | $66.07 | $95.50 |
Ambetter Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | None | $38.02 | $38.02 | $38.02 |
BCBS Michigan Setting Facility Modifier None Typical Low $741.31 Median $933.25 Typical High $2,290.87 | Facility | None | $741.31 | $933.25 | $2,290.87 |
BCBS Michigan Setting Professional Modifier None Typical Low $7.41 Median $58.88 Typical High $100.00 | Professional | None | $7.41 | $58.88 | $100.00 |
CareSource Setting Professional Modifier None Typical Low $66.07 Median $67.61 Typical High $93.33 | Professional | None | $66.07 | $67.61 | $93.33 |
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 $36.31 Median $67.61 Typical High $141.25 | Professional | None | $36.31 | $67.61 | $141.25 |
Health Alliance Plan Setting Facility Modifier None Typical Low $93.33 Median $575.44 Typical High $2,187.76 | Facility | None | $93.33 | $575.44 | $2,187.76 |
Health Alliance Plan Setting Professional Modifier None Typical Low $52.48 Median $93.33 Typical High $138.04 | Professional | None | $52.48 | $93.33 | $138.04 |
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 $34.67 Median $61.66 Typical High $117.49 | Professional | None | $34.67 | $61.66 | $117.49 |
United Setting Facility Modifier None Typical Low $288.40 Median $426.58 Typical High $1,995.26 | Facility | None | $288.40 | $426.58 | $1,995.26 |
United Setting Professional Modifier None Typical Low $50.12 Median $85.11 Typical High $117.49 | Professional | None | $50.12 | $85.11 | $117.49 |
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 $26.30 Median $33.88 Typical High $46.77 | Professional | 52 · Reduced service | $26.30 | $33.88 | $46.77 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $13.80 Typical High $18.62 | Professional | 53 · Discontinued | $10.47 | $13.80 | $18.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $39.81 Median $51.29 Typical High $69.18 | Professional | 54 · Surgery only | $39.81 | $51.29 | $69.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $10.23 Typical High $13.80 | Professional | 55 · Aftercare only | $7.94 | $10.23 | $13.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $6.92 Typical High $9.33 | Professional | 56 · Pre-op care only | $5.25 | $6.92 | $9.33 |
BCBS Michigan Setting Professional Modifier 50 · Both sides Typical Low $70.79 Median $112.20 Typical High $147.91 | Professional | 50 · Both sides | $70.79 | $112.20 | $147.91 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $26.92 Median $33.88 Typical High $48.98 | Professional | 52 · Reduced service | $26.92 | $33.88 | $48.98 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $10.72 Median $13.80 Typical High $19.50 | Professional | 53 · Discontinued | $10.72 | $13.80 | $19.50 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $39.81 Median $51.29 Typical High $72.44 | Professional | 54 · Surgery only | $39.81 | $51.29 | $72.44 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $10.23 Typical High $14.45 | Professional | 55 · Aftercare only | $7.94 | $10.23 | $14.45 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $5.37 Median $6.92 Typical High $9.77 | Professional | 56 · Pre-op care only | $5.37 | $6.92 | $9.77 |
Health Alliance Plan Setting Professional Modifier 59 · Distinct service Typical Low $15.49 Median $41.69 Typical High $1,047.13 | Professional | 59 · Distinct service | $15.49 | $41.69 | $1,047.13 |
Where Michigan sits
The same service costs 3.5 times more in Alaska than in Virginia. 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· 36th of 51
$77.62
AK $204VA $58.88
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.