Commercial healthcare reimbursement in Michigan
How Michigan compares with the nation, by payer, specialty and procedure.
Michigan at a glance
What the data shows
Michigan ranks 40th of 51 states for commercial reimbursement, with an index of 90 (100 = national median) across 228 procedure codes; the Midwest region averages 115.
Commercial rates in Michigan run a median 145% of Medicare.
Cigna has the highest index in the state (123) and Aetna the lowest (92), a 31-point gap, in the files analyzed.
CPT 88313 (Special stains group 2) is the strongest relative to the national median (137% of it, a 37% premium); CPT 51720 (Treatment of bladder lesion) is furthest below (50% of the national median, 50% lower).
By specialty, Michigan is strongest for ophthalmology (ranks 22nd of 50 states for that specialty) and weakest for gastroenterology (47th of 50).
Against Medicare, gastroenterology has the highest ratio in Michigan (155% of Medicare) and internal medicine the lowest (93%).
Payer ranking in Michigan
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| Cigna | 123 | 1 | 55 | 93 | 145 | |
| UnitedHealthcare | 106 | 2 | 228 | 664 | 533 | |
| Blue Cross Blue Shield | 100 | 3 | 228 | 846 | 1,064 | |
| Aetna | 92 | 4 | 228 | 707 | 608 |
Reimbursement index by specialty in Michigan
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Ophthalmology | 102 | 22 of 50 | 120% | 42 | 113 | |
| Dermatology | 97 | 29 of 50 | 93% | 44 | 108 | |
| Diagnostic radiology | 93 | 35 of 51 | 147% | 49 | 117 | |
| Cardiology | 90 | 38 of 51 | 141% | 38 | 124 | |
| Internal medicine | 83 | 42 of 51 | 93% | 25 | 106 | |
| Orthopedic surgery | 87 | 43 of 51 | 122% | 39 | 103 | |
| Urology | 84 | 45 of 50 | 142% | 37 | 113 | |
| Gastroenterology | 84 | 47 of 50 | 155% | 36 | 114 |
Specialty by payer in Michigan
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 83 | 72 | n/a | 87 |
| Dermatology | 110 | 83 | n/a | 96 |
| Ophthalmology | 108 | 98 | n/a | 106 |
| Cardiology | 89 | 78 | n/a | 96 |
| Orthopedic surgery | 82 | 82 | n/a | 95 |
| Diagnostic radiology | 97 | 77 | 116 | 95 |
| Urology | 94 | 73 | n/a | 85 |
| Gastroenterology | 96 | 74 | n/a | 83 |
Michigan compared with Midwest region states
Procedures that pay most and least in Michigan vs the nation
Highest vs national
| Code | Michigan | National | Gap | Prov. |
|---|---|---|---|---|
| 88313 Special stains group 2 | $97 | $71 | +37% | 109 |
| 88312 Special stains group 1 | $131 | $97 | +34% | 217 |
| 88342 Imhchem/imcytchm 1st antb | $120 | $95 | +26% | 108 |
| 88305 Tissue exam by pathologist | $86 | $70 | +23% | 220 |
| 65820 Goniotomy | $1,098 | $955 | +15% | 112 |
| 92250 Fundus photography w/i&r | $59 | $53 | +13% | 112 |
| 92134 Cptrz oph dx img pst sgm rta | $50 | $45 | +12% | 112 |
| 15823 Blepharp upr eyelid xcsv skn | $755 | $677 | +12% | 112 |
| 66821 After cataract laser surgery | $434 | $393 | +10% | 112 |
| 65756 Corneal trnspl endothelial | $1,569 | $1,425 | +10% | 110 |
| 92235 Fluorescein angrph mltiframe | $158 | $145 | +9% | 112 |
| 92025 Cptrized corneal topography | $43 | $40 | +8% | 112 |
| 92273 Full field erg w/i&r | $154 | $142 | +8% | 112 |
| 92133 Cptrzd oph dx img pst sgm on | $45 | $42 | +7% | 112 |
| 67036 Removal of inner eye fluid | $1,194 | $1,117 | +7% | 112 |
Lowest vs national
| Code | Michigan | National | Gap | Prov. |
|---|---|---|---|---|
| 51720 Treatment of bladder lesion | $56 | $111 | -50% | 111 |
| 51700 Irrigation of bladder | $40 | $77 | -49% | 112 |
| 52000 Cystourethroscopy | $118 | $210 | -44% | 112 |
| 52648 Laser surgery of prostate | $878 | $1,508 | -42% | 110 |
| 43239 Egd biopsy single/multiple | $204 | $349 | -42% | 113 |
| 45384 Colonoscopy w/lesion removal | $314 | $519 | -39% | 111 |
| 51702 Insert temp bladder cath | $38 | $61 | -38% | 112 |
| 43235 Egd diagnostic brush wash | $183 | $294 | -38% | 113 |
| 64566 Neuroeltrd stim post tibial | $43 | $69 | -38% | 111 |
| 45380 Colonoscopy and biopsy | $294 | $470 | -38% | 113 |
| 52224 Cystoscopy and treatment | $290 | $459 | -37% | 111 |
| 43255 Egd control bleeding any | $293 | $459 | -36% | 113 |
| 45378 Diagnostic colonoscopy | $272 | $408 | -33% | 113 |
| 52287 Cystoscopy chemodenervation | $246 | $367 | -33% | 111 |
| 43248 Egd guide wire insertion | $245 | $364 | -33% | 112 |
Frequently asked questions
How do commercial reimbursement rates in Michigan compare with the rest of the country?
Michigan ranks 40th of 51 states with an index of 90, across 228 procedure codes. Median commercial rates run 145% of the Medicare rate.
Which payer has the highest rates in Michigan?
In the files we analyzed, Cigna has the highest index (123) and Aetna the lowest (92). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in Michigan?
Ophthalmology ranks 22nd of 50 states.
How many providers does this Michigan page cover?
898 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between Michigan and the national median?
CPT 88313 (Special stains group 2) is highest relative to the nation at 137% of the national median; CPT 51720 (Treatment of bladder lesion) is lowest at 50%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Michigan contracts
Compare your negotiated rates with these state medians by payer and specialty.