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 $109.65 Median $158.49 Typical High $1,737.80 | Facility | None | $109.65 | $158.49 | $1,737.80 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $147.91 Typical High $181.97 | Professional | None | $109.65 | $147.91 | $181.97 |
Ambetter Setting Professional Modifier None Typical Low $63.10 Median $141.25 Typical High $141.25 | Professional | None | $63.10 | $141.25 | $141.25 |
BCBS Alabama Setting Facility Modifier None Typical Low $645.65 Median $645.65 Typical High $645.65 | Facility | None | $645.65 | $645.65 | $645.65 |
Cigna Setting Facility Modifier None Typical Low $112.20 Median $141.25 Typical High $501.19 | Facility | None | $112.20 | $141.25 | $501.19 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $123.03 Typical High $151.36 | Professional | None | $104.71 | $123.03 | $151.36 |
United Setting Facility Modifier None Typical Low $309.03 Median $616.60 Typical High $2,511.89 | Facility | None | $309.03 | $616.60 | $2,511.89 |
United Setting Professional Modifier None Typical Low $95.50 Median $134.90 Typical High $190.55 | Professional | None | $95.50 | $134.90 | $190.55 |
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 $54.95 Median $67.61 Typical High $79.43 | Professional | 52 · Reduced service | $54.95 | $67.61 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $26.92 Typical High $32.36 | Professional | 53 · Discontinued | $21.88 | $26.92 | $32.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $100.00 Typical High $120.23 | Professional | 54 · Surgery only | $83.18 | $100.00 | $120.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $19.95 Typical High $23.99 | Professional | 55 · Aftercare only | $16.60 | $19.95 | $23.99 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $13.49 Typical High $15.85 | Professional | 56 · Pre-op care only | $10.96 | $13.49 | $15.85 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $77.62 Median $93.33 Typical High $112.20 | Professional | 78 · Unplanned return to OR | $77.62 | $93.33 | $112.20 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 Typical Low $67.61 Median $91.20 Typical High $151.36 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 | $67.61 | $91.20 | $151.36 |
Where Alabama sits
The same service costs 3.8 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· 45th of 51
$151
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.