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 $616.60 Median $1,122.02 Typical High $1,905.46 | Facility | None | $616.60 | $1,122.02 | $1,905.46 |
Aetna Setting Professional Modifier None Typical Low $102.33 Median $125.89 Typical High $151.36 | Professional | None | $102.33 | $125.89 | $151.36 |
Ambetter Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $40.74 | Professional | None | $40.74 | $40.74 | $40.74 |
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 $100.00 Median $123.03 Typical High $501.19 | Facility | None | $100.00 | $123.03 | $501.19 |
Cigna Setting Professional Modifier None Typical Low $95.50 Median $100.00 Typical High $125.89 | Professional | None | $95.50 | $100.00 | $125.89 |
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 $85.11 Median $112.20 Typical High $173.78 | Professional | None | $85.11 | $112.20 | $173.78 |
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 $51.29 Median $57.54 Typical High $66.07 | Professional | 52 · Reduced service | $51.29 | $57.54 | $66.07 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $22.91 Typical High $26.30 | Professional | 53 · Discontinued | $20.42 | $22.91 | $26.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $85.11 Typical High $100.00 | Professional | 54 · Surgery only | $75.86 | $85.11 | $100.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $16.98 Typical High $19.95 | Professional | 55 · Aftercare only | $15.14 | $16.98 | $19.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $11.48 Typical High $13.18 | Professional | 56 · Pre-op care only | $10.23 | $11.48 | $13.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $70.79 Median $79.43 Typical High $93.33 | Professional | 78 · Unplanned return to OR | $70.79 | $79.43 | $93.33 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 Typical Low $61.66 Median $85.11 Typical High $138.04 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 | $61.66 | $85.11 | $138.04 |
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· 45th of 51
$126
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.