How much rates vary
Facilitymedian $151 · 10th to 90th $112 to $457Professionalmedian $155 · 10th to 90th $115 to $214
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 $112.20 Median $151.36 Typical High $151.36 | Facility | None | $112.20 | $151.36 | $151.36 |
Aetna Setting Professional Modifier None Typical Low $112.20 Median $134.90 Typical High $181.97 | Professional | None | $112.20 | $134.90 | $181.97 |
Ambetter Setting Professional Modifier None Typical Low $134.90 Median $177.83 Typical High $181.97 | Professional | None | $134.90 | $177.83 | $181.97 |
BCBS Michigan Setting Facility Modifier None Typical Low $213.80 Median $213.80 Typical High $213.80 | Facility | None | $213.80 | $213.80 | $213.80 |
BCBS Michigan Setting Professional Modifier None Typical Low $204.17 Median $213.80 Typical High $223.87 | Professional | None | $204.17 | $213.80 | $223.87 |
CareSource Setting Professional Modifier None Typical Low $128.82 Median $177.83 Typical High $208.93 | Professional | None | $128.82 | $177.83 | $208.93 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $162.18 Typical High $316.23 | Professional | None | $117.49 | $162.18 | $316.23 |
Health Alliance Plan Setting Facility Modifier None Typical Low $128.82 Median $151.36 Typical High $467.74 | Facility | None | $128.82 | $151.36 | $467.74 |
Health Alliance Plan Setting Professional Modifier None Typical Low $128.82 Median $151.36 Typical High $223.87 | Professional | None | $128.82 | $151.36 | $223.87 |
Priority Health Setting Professional Modifier None Typical Low $109.65 Median $154.88 Typical High $302.00 | Professional | None | $109.65 | $154.88 | $302.00 |
United Setting Professional Modifier None Typical Low $158.49 Median $181.97 Typical High $223.87 | Professional | None | $158.49 | $181.97 | $223.87 |
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 $74.13 Median $75.86 Typical High $75.86 | Professional | 52 · Reduced service | $74.13 | $75.86 | $75.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $22.39 Typical High $22.39 | Professional | 55 · Aftercare only | $22.39 | $22.39 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | 56 · Pre-op care only | $15.14 | $15.14 | $15.14 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | 57 · Decision for surgery | $204.17 | $204.17 | $204.17 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $134.90 Median $181.97 Typical High $181.97 | Professional | GC · Resident with teaching physician | $134.90 | $181.97 | $181.97 |
Health Alliance Plan Setting Professional Modifier 25 · Same-day visit Typical Low $151.36 Median $302.00 Typical High $588.84 | Professional | 25 · Same-day visit | $151.36 | $302.00 | $588.84 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | 52 · Reduced service | $74.13 | $74.13 | $74.13 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $22.39 Typical High $22.39 | Professional | 55 · Aftercare only | $22.39 | $22.39 | $22.39 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | 56 · Pre-op care only | $15.14 | $15.14 | $15.14 |
Health Alliance Plan Setting Professional Modifier GC · Resident with teaching physician Typical Low $234.42 Median $257.04 Typical High $407.38 | Professional | GC · Resident with teaching physician | $234.42 | $257.04 | $407.38 |
Where Michigan sits
The same service costs 2.4 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· 34th of 51
$155
AK $288AL $120
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.