How much rates vary
Facilitymedian $83 · 10th to 90th $62 to $186Professionalmedian $83 · 10th to 90th $62 to $123
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $61.66 Median $81.28 Typical High $83.18 | Facility | None | $61.66 | $81.28 | $83.18 |
Aetna Setting Professional Modifier None Typical Low $61.66 Median $70.79 Typical High $93.33 | Professional | None | $61.66 | $70.79 | $93.33 |
Ambetter Setting Professional Modifier None Typical Low $74.13 Median $85.11 Typical High $100.00 | Professional | None | $74.13 | $85.11 | $100.00 |
BCBS Michigan Setting Facility Modifier None Typical Low $102.33 Median $120.23 Typical High $138.04 | Facility | None | $102.33 | $120.23 | $138.04 |
BCBS Michigan Setting Professional Modifier None Typical Low $102.33 Median $123.03 Typical High $138.04 | Professional | None | $102.33 | $123.03 | $138.04 |
CareSource Setting Facility Modifier None Typical Low $102.33 Median $102.33 Typical High $102.33 | Facility | None | $102.33 | $102.33 | $102.33 |
CareSource Setting Professional Modifier None Typical Low $75.86 Median $104.71 Typical High $123.03 | Professional | None | $75.86 | $104.71 | $123.03 |
Cigna Setting Professional Modifier None Typical Low $60.26 Median $77.62 Typical High $158.49 | Professional | None | $60.26 | $77.62 | $158.49 |
Health Alliance Plan Setting Facility Modifier None Typical Low $70.79 Median $83.18 Typical High $204.17 | Facility | None | $70.79 | $83.18 | $204.17 |
Health Alliance Plan Setting Professional Modifier None Typical Low $63.10 Median $81.28 Typical High $114.82 | Professional | None | $63.10 | $81.28 | $114.82 |
Priority Health Setting Professional Modifier None Typical Low $56.23 Median $72.44 Typical High $158.49 | Professional | None | $56.23 | $72.44 | $158.49 |
United Setting Professional Modifier None Typical Low $67.61 Median $79.43 Typical High $100.00 | Professional | None | $67.61 | $79.43 | $100.00 |
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 $34.67 Median $41.69 Typical High $41.69 | Professional | 52 · Reduced service | $34.67 | $41.69 | $41.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.23 Median $12.30 Typical High $12.30 | Professional | 55 · Aftercare only | $10.23 | $12.30 | $12.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.92 Median $8.32 Typical High $8.32 | Professional | 56 · Pre-op care only | $6.92 | $8.32 | $8.32 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $67.61 Median $77.62 Typical High $77.62 | Professional | 25 · Same-day visit | $67.61 | $77.62 | $77.62 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $85.11 Median $89.13 Typical High $104.71 | Professional | FS · Shared visit | $85.11 | $89.13 | $104.71 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $74.13 Median $74.13 Typical High $104.71 | Professional | GC · Resident with teaching physician | $74.13 | $74.13 | $104.71 |
Health Alliance Plan Setting Professional Modifier 25 · Same-day visit Typical Low $79.43 Median $125.89 Typical High $199.53 | Professional | 25 · Same-day visit | $79.43 | $125.89 | $199.53 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $41.69 Median $41.69 Typical High $41.69 | Professional | 52 · Reduced service | $41.69 | $41.69 | $41.69 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $12.30 Typical High $12.30 | Professional | 55 · Aftercare only | $12.30 | $12.30 | $12.30 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $8.32 Typical High $8.32 | Professional | 56 · Pre-op care only | $8.32 | $8.32 | $8.32 |
Health Alliance Plan Setting Professional Modifier FS · Shared visit Typical Low $79.43 Median $117.49 Typical High $147.91 | Professional | FS · Shared visit | $79.43 | $117.49 | $147.91 |
Health Alliance Plan Setting Professional Modifier GC · Resident with teaching physician Typical Low $75.86 Median $109.65 Typical High $181.97 | Professional | GC · Resident with teaching physician | $75.86 | $109.65 | $181.97 |
Where Michigan sits
The same service costs 2.3 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· 23rd of 51
$83.18
AK $155NJ $67.61
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.