How much rates vary
Facilitymedian $123 · 10th to 90th $91 to $269Professionalmedian $115 · 10th to 90th $89 to $148
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 $89.13 Median $120.23 Typical High $128.82 | Facility | None | $89.13 | $120.23 | $128.82 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $102.33 Typical High $125.89 | Professional | None | $89.13 | $102.33 | $125.89 |
Ambetter Setting Professional Modifier None Typical Low $89.13 Median $107.15 Typical High $144.54 | Professional | None | $89.13 | $107.15 | $144.54 |
BCBS Michigan Setting Facility Modifier None Typical Low $107.15 Median $147.91 Typical High $147.91 | Facility | None | $107.15 | $147.91 | $147.91 |
BCBS Michigan Setting Professional Modifier None Typical Low $117.49 Median $125.89 Typical High $147.91 | Professional | None | $117.49 | $125.89 | $147.91 |
CareSource Setting Facility Modifier None Typical Low $144.54 Median $144.54 Typical High $144.54 | Facility | None | $144.54 | $144.54 | $144.54 |
CareSource Setting Professional Modifier None Typical Low $112.20 Median $154.88 Typical High $181.97 | Professional | None | $112.20 | $154.88 | $181.97 |
Cigna Setting Professional Modifier None Typical Low $77.62 Median $112.20 Typical High $257.04 | Professional | None | $77.62 | $112.20 | $257.04 |
Health Alliance Plan Setting Facility Modifier None Typical Low $91.20 Median $123.03 Typical High $288.40 | Facility | None | $91.20 | $123.03 | $288.40 |
Health Alliance Plan Setting Professional Modifier None Typical Low $91.20 Median $112.20 Typical High $162.18 | Professional | None | $91.20 | $112.20 | $162.18 |
Priority Health Setting Professional Modifier None Typical Low $77.62 Median $104.71 Typical High $257.04 | Professional | None | $77.62 | $104.71 | $257.04 |
United Setting Professional Modifier None Typical Low $93.33 Median $114.82 Typical High $144.54 | Professional | None | $93.33 | $114.82 | $144.54 |
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 $51.29 Median $60.26 Typical High $60.26 | Professional | 52 · Reduced service | $51.29 | $60.26 | $60.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $17.78 Typical High $18.20 | Professional | 55 · Aftercare only | $15.14 | $17.78 | $18.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $12.02 Typical High $12.02 | Professional | 56 · Pre-op care only | $10.23 | $12.02 | $12.02 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $104.71 Median $158.49 Typical High $158.49 | Professional | 25 · Same-day visit | $104.71 | $158.49 | $158.49 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | 57 · Decision for surgery | $109.65 | $109.65 | $109.65 |
Ambetter Setting Professional Modifier AM · Physician, team member Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | AM · Physician, team member | $109.65 | $109.65 | $109.65 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $104.71 Median $104.71 Typical High $125.89 | Professional | FS · Shared visit | $104.71 | $104.71 | $125.89 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $104.71 Median $144.54 Typical High $144.54 | Professional | GC · Resident with teaching physician | $104.71 | $144.54 | $144.54 |
Health Alliance Plan Setting Professional Modifier 25 · Same-day visit Typical Low $87.10 Median $162.18 Typical High $354.81 | Professional | 25 · Same-day visit | $87.10 | $162.18 | $354.81 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $61.66 Median $61.66 Typical High $61.66 | Professional | 52 · Reduced service | $61.66 | $61.66 | $61.66 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $18.62 Typical High $18.62 | Professional | 55 · Aftercare only | $18.62 | $18.62 | $18.62 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $12.30 Typical High $12.30 | Professional | 56 · Pre-op care only | $12.30 | $12.30 | $12.30 |
Health Alliance Plan Setting Professional Modifier FS · Shared visit Typical Low $95.50 Median $114.82 Typical High $208.93 | Professional | FS · Shared visit | $95.50 | $114.82 | $208.93 |
Health Alliance Plan Setting Professional Modifier GC · Resident with teaching physician Typical Low $83.18 Median $158.49 Typical High $257.04 | Professional | GC · Resident with teaching physician | $83.18 | $158.49 | $257.04 |
Where Michigan sits
The same service costs 2.5 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· 20th of 51
$115
AK $229NJ $93.33
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.