How much rates vary
Facilitymedian $54 · 10th to 90th $30 to $123Professionalmedian $44 · 10th to 90th $28 to $60
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 $26.92 Median $38.02 Typical High $57.54 | Facility | None | $26.92 | $38.02 | $57.54 |
Aetna Setting Professional Modifier None Typical Low $26.92 Median $41.69 Typical High $57.54 | Professional | None | $26.92 | $41.69 | $57.54 |
Ambetter Setting Professional Modifier None Typical Low $27.54 Median $45.71 Typical High $72.44 | Professional | None | $27.54 | $45.71 | $72.44 |
BCBS Michigan Setting Facility Modifier None Typical Low $40.74 Median $77.62 Typical High $162.18 | Facility | None | $40.74 | $77.62 | $162.18 |
BCBS Michigan Setting Professional Modifier None Typical Low $51.29 Median $51.29 Typical High $66.07 | Professional | None | $51.29 | $51.29 | $66.07 |
CareSource Setting Professional Modifier None Typical Low $51.29 Median $69.18 Typical High $81.28 | Professional | None | $51.29 | $69.18 | $81.28 |
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 $26.92 Median $42.66 Typical High $67.61 | Professional | None | $26.92 | $42.66 | $67.61 |
Health Alliance Plan Setting Facility Modifier None Typical Low $30.90 Median $57.54 Typical High $128.82 | Facility | None | $30.90 | $57.54 | $128.82 |
Health Alliance Plan Setting Professional Modifier None Typical Low $27.54 Median $44.67 Typical High $60.26 | Professional | None | $27.54 | $44.67 | $60.26 |
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 $30.20 Median $42.66 Typical High $54.95 | Professional | None | $30.20 | $42.66 | $54.95 |
United Setting Professional Modifier None Typical Low $24.55 Median $35.48 Typical High $51.29 | Professional | None | $24.55 | $35.48 | $51.29 |
14 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 $17.78 Median $19.95 Typical High $28.18 | Professional | 52 · Reduced service | $17.78 | $19.95 | $28.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.37 Median $6.46 Typical High $8.51 | Professional | 55 · Aftercare only | $5.37 | $6.46 | $8.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.55 Median $3.98 Typical High $5.75 | Professional | 56 · Pre-op care only | $3.55 | $3.98 | $5.75 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | 24 · Unrelated visit after surgery | $60.26 | $60.26 | $60.26 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $50.12 Median $56.23 Typical High $63.10 | Professional | 25 · Same-day visit | $50.12 | $56.23 | $63.10 |
Ambetter Setting Professional Modifier 93 · Audio-only telehealth Typical Low $26.30 Median $41.69 Typical High $56.23 | Professional | 93 · Audio-only telehealth | $26.30 | $41.69 | $56.23 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $30.90 Median $30.90 Typical High $67.61 | Professional | GC · Resident with teaching physician | $30.90 | $30.90 | $67.61 |
BCBS Michigan Setting Professional Modifier HO · Master's level Typical Low $54.95 Median $54.95 Typical High $54.95 | Professional | HO · Master's level | $54.95 | $54.95 | $54.95 |
Health Alliance Plan Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $40.74 Median $64.57 Typical High $74.13 | Professional | 24 · Unrelated visit after surgery | $40.74 | $64.57 | $74.13 |
Health Alliance Plan Setting Professional Modifier 25 · Same-day visit Typical Low $28.18 Median $58.88 Typical High $120.23 | Professional | 25 · Same-day visit | $28.18 | $58.88 | $120.23 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $18.20 Median $18.20 Typical High $28.84 | Professional | 52 · Reduced service | $18.20 | $18.20 | $28.84 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $5.50 Typical High $8.51 | Professional | 55 · Aftercare only | $5.50 | $5.50 | $8.51 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $3.63 Median $3.89 Typical High $5.75 | Professional | 56 · Pre-op care only | $3.63 | $3.89 | $5.75 |
Health Alliance Plan Setting Professional Modifier GQ · Store-and-forward telehealth Typical Low $48.98 Median $48.98 Typical High $48.98 | Professional | GQ · Store-and-forward telehealth | $48.98 | $48.98 | $48.98 |
Where Michigan sits
The same service costs 2.4 times more in Alaska than in New Jersey. 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· 25th of 51
$43.65
AK $77.62NJ $32.36
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.