How much rates vary
Facilitymedian $6,457 · 10th to 90th $1,230 to $12,589Professionalmedian $275 · 10th to 90th $214 to $316
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 $4,786.30 Median $4,897.79 Typical High $6,918.31 | Facility | None | $4,786.30 | $4,897.79 | $6,918.31 |
Aetna Setting Professional Modifier None (both parts) Typical Low $186.21 Median $891.25 Typical High $4,168.69 | Professional | None (both parts) | $186.21 | $891.25 | $4,168.69 |
Aetna Setting Professional Modifier 26 · Professional part Typical Low $199.53 Median $239.88 Typical High $245.47 | Professional | 26 · Professional part | $199.53 | $239.88 | $245.47 |
BCBS Michigan Setting Facility Modifier None Typical Low $3,715.35 Median $9,332.54 Typical High $18,620.87 | Facility | None | $3,715.35 | $9,332.54 | $18,620.87 |
BCBS Michigan Setting Professional Modifier None (both parts) Typical Low $275.42 Median $288.40 Typical High $288.40 | Professional | None (both parts) | $275.42 | $288.40 | $288.40 |
Cigna Setting Professional Modifier 26 · Professional part Typical Low $134.90 Median $281.84 Typical High $309.03 | Professional | 26 · Professional part | $134.90 | $281.84 | $309.03 |
Health Alliance Plan Setting Facility Modifier None Typical Low $4,786.30 Median $4,897.79 Typical High $7,585.78 | Facility | None | $4,786.30 | $4,897.79 | $7,585.78 |
Health Alliance Plan Setting Professional Modifier None (both parts) Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | None (both parts) | $186.21 | $186.21 | $186.21 |
Health Alliance Plan Setting Professional Modifier 26 · Professional part Typical Low $186.21 Median $218.78 Typical High $263.03 | Professional | 26 · Professional part | $186.21 | $218.78 | $263.03 |
Priority Health Setting Professional Modifier 26 · Professional part Typical Low $134.90 Median $257.04 Typical High $302.00 | Professional | 26 · Professional part | $134.90 | $257.04 | $302.00 |
United Setting Facility Modifier None Typical Low $1,047.13 Median $4,073.80 Typical High $10,232.93 | Facility | None | $1,047.13 | $4,073.80 | $10,232.93 |
United Setting Professional Modifier None (both parts) Typical Low $204.17 Median $239.88 Typical High $323.59 | Professional | None (both parts) | $204.17 | $239.88 | $323.59 |
United Setting Professional Modifier 26 · Professional part Typical Low $204.17 Median $239.88 Typical High $323.59 | Professional | 26 · Professional part | $204.17 | $239.88 | $323.59 |
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 $112.20 Median $117.49 Typical High $123.03 | Professional | 52 · Reduced service | $112.20 | $117.49 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $44.67 Median $47.86 Typical High $48.98 | Professional | 53 · Discontinued | $44.67 | $47.86 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $169.82 Median $177.83 Typical High $186.21 | Professional | 54 · Surgery only | $169.82 | $177.83 | $186.21 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $35.48 Typical High $37.15 | Professional | 55 · Aftercare only | $33.88 | $35.48 | $37.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.39 Median $23.99 Typical High $24.55 | Professional | 56 · Pre-op care only | $22.39 | $23.99 | $24.55 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | 52 · Reduced service | $123.03 | $123.03 | $123.03 |
Health Alliance Plan Setting Professional Modifier 53 · Discontinued Typical Low $48.98 Median $48.98 Typical High $48.98 | Professional | 53 · Discontinued | $48.98 | $48.98 | $48.98 |
Health Alliance Plan Setting Professional Modifier 54 · Surgery only Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | 54 · Surgery only | $186.21 | $186.21 | $186.21 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $37.15 Median $37.15 Typical High $37.15 | Professional | 55 · Aftercare only | $37.15 | $37.15 | $37.15 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $24.55 Median $24.55 Typical High $24.55 | Professional | 56 · Pre-op care only | $24.55 | $24.55 | $24.55 |
Where Michigan sits
The same service costs 28.8 times more in Colorado 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· 47th of 51
$288
CO $7,079KY $245
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.