How much rates vary
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 $100.00 Median $691.83 Typical High $1,862.09 | Facility | None | $100.00 | $691.83 | $1,862.09 |
Aetna Setting Professional Modifier None Typical Low $100.00 Median $147.91 Typical High $223.87 | Professional | None | $100.00 | $147.91 | $223.87 |
Ambetter Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $218.78 | Professional | None | $218.78 | $218.78 | $218.78 |
BCBS Alabama Setting Facility Modifier None Typical Low $239.88 Median $239.88 Typical High $239.88 | Facility | None | $239.88 | $239.88 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $223.87 Typical High $446.68 | Facility | None | $50.12 | $223.87 | $446.68 |
Cigna Setting Professional Modifier None Typical Low $100.00 Median $154.88 Typical High $257.04 | Professional | None | $100.00 | $154.88 | $257.04 |
United Setting Facility Modifier None Typical Low $316.23 Median $645.65 Typical High $2,511.89 | Facility | None | $316.23 | $645.65 | $2,511.89 |
United Setting Professional Modifier None Typical Low $85.11 Median $158.49 Typical High $194.98 | Professional | None | $85.11 | $158.49 | $194.98 |
7 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 $50.12 Median $70.79 Typical High $112.20 | Professional | 52 · Reduced service | $50.12 | $70.79 | $112.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $28.18 Typical High $44.67 | Professional | 53 · Discontinued | $19.95 | $28.18 | $44.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $104.71 Typical High $169.82 | Professional | 54 · Surgery only | $74.13 | $104.71 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $20.89 Typical High $33.88 | Professional | 55 · Aftercare only | $14.79 | $20.89 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $14.13 Typical High $22.39 | Professional | 56 · Pre-op care only | $10.00 | $14.13 | $22.39 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $97.72 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $69.18 | $97.72 | $158.49 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 Typical Low $60.26 Median $83.18 Typical High $144.54 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 | $60.26 | $83.18 | $144.54 |
Where Alabama sits
The same service costs 4.1 times more in Alaska than in Kentucky. 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.
Alabama· 36th of 51
$195
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.