How much rates vary
Facilitymedian $95 · 10th to 90th $65 to $209Professionalmedian $95 · 10th to 90th $69 to $126
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 $63.10 Median $85.11 Typical High $114.82 | Facility | None | $63.10 | $85.11 | $114.82 |
Aetna Setting Professional Modifier None Typical Low $63.10 Median $85.11 Typical High $114.82 | Professional | None | $63.10 | $85.11 | $114.82 |
Ambetter Setting Professional Modifier None Typical Low $70.79 Median $95.50 Typical High $120.23 | Professional | None | $70.79 | $95.50 | $120.23 |
BCBS Michigan Setting Facility Modifier None Typical Low $74.13 Median $138.04 Typical High $288.40 | Facility | None | $74.13 | $138.04 | $288.40 |
BCBS Michigan Setting Professional Modifier None Typical Low $109.65 Median $109.65 Typical High $125.89 | Professional | None | $109.65 | $109.65 | $125.89 |
CareSource Setting Facility Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Facility | None | $162.18 | $162.18 | $162.18 |
CareSource Setting Professional Modifier None Typical Low $102.33 Median $138.04 Typical High $162.18 | Professional | None | $102.33 | $138.04 | $162.18 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $151.36 Typical High $151.36 | Facility | None | $151.36 | $151.36 | $151.36 |
Cigna Setting Professional Modifier None Typical Low $77.62 Median $104.71 Typical High $144.54 | Professional | None | $77.62 | $104.71 | $144.54 |
Health Alliance Plan Setting Facility Modifier None Typical Low $64.57 Median $93.33 Typical High $218.78 | Facility | None | $64.57 | $93.33 | $218.78 |
Health Alliance Plan Setting Professional Modifier None Typical Low $64.57 Median $97.72 Typical High $147.91 | Professional | None | $64.57 | $97.72 | $147.91 |
Priority Health Setting Facility Modifier None Typical Low $151.36 Median $151.36 Typical High $151.36 | Facility | None | $151.36 | $151.36 | $151.36 |
Priority Health Setting Professional Modifier None Typical Low $81.28 Median $104.71 Typical High $123.03 | Professional | None | $81.28 | $104.71 | $123.03 |
United Setting Professional Modifier None Typical Low $72.44 Median $89.13 Typical High $120.23 | Professional | None | $72.44 | $89.13 | $120.23 |
15 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 $41.69 Median $42.66 Typical High $57.54 | Professional | 52 · Reduced service | $41.69 | $42.66 | $57.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $12.88 Typical High $16.98 | Professional | 55 · Aftercare only | $12.59 | $12.88 | $16.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $8.71 Typical High $11.48 | Professional | 56 · Pre-op care only | $8.32 | $8.71 | $11.48 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $63.10 Median $112.20 Typical High $162.18 | Professional | 25 · Same-day visit | $63.10 | $112.20 | $162.18 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | 57 · Decision for surgery | $112.20 | $112.20 | $112.20 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $70.79 Median $125.89 Typical High $154.88 | Professional | GC · Resident with teaching physician | $70.79 | $125.89 | $154.88 |
BCBS Michigan Setting Professional Modifier HO · Master's level Typical Low $117.49 Median $117.49 Typical High $117.49 | Professional | HO · Master's level | $117.49 | $117.49 | $117.49 |
Health Alliance Plan Setting Professional Modifier 25 · Same-day visit Typical Low $67.61 Median $138.04 Typical High $295.12 | Professional | 25 · Same-day visit | $67.61 | $138.04 | $295.12 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $42.66 Median $42.66 Typical High $57.54 | Professional | 52 · Reduced service | $42.66 | $42.66 | $57.54 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $12.88 Typical High $16.98 | Professional | 55 · Aftercare only | $12.88 | $12.88 | $16.98 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $8.51 Typical High $11.48 | Professional | 56 · Pre-op care only | $8.51 | $8.51 | $11.48 |
Health Alliance Plan Setting Professional Modifier 57 · Decision for surgery Typical Low $85.11 Median $177.83 Typical High $208.93 | Professional | 57 · Decision for surgery | $85.11 | $177.83 | $208.93 |
Health Alliance Plan Setting Professional Modifier 59 · Distinct service Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | 59 · Distinct service | $204.17 | $204.17 | $204.17 |
Health Alliance Plan Setting Professional Modifier GC · Resident with teaching physician Typical Low $114.82 Median $144.54 Typical High $363.08 | Professional | GC · Resident with teaching physician | $114.82 | $144.54 | $363.08 |
Health Alliance Plan Setting Professional Modifier GF · Non-physician, rural hospital Typical Low $194.98 Median $281.84 Typical High $281.84 | Professional | GF · Non-physician, rural hospital | $194.98 | $281.84 | $281.84 |
Where Michigan sits
The same service costs 2.3 times more in Alaska than in Alabama. 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· 33rd of 51
$95.50
AK $170AL $74.13
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.