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 $141.25 Median $831.76 Typical High $1,862.09 | Facility | None | $141.25 | $831.76 | $1,862.09 |
Aetna Setting Professional Modifier None Typical Low $141.25 Median $173.78 Typical High $208.93 | Professional | None | $141.25 | $173.78 | $208.93 |
Ambetter Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $120.23 | Professional | None | $120.23 | $120.23 | $120.23 |
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 $123.03 Median $151.36 Typical High $501.19 | Facility | None | $123.03 | $151.36 | $501.19 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $138.04 Typical High $173.78 | Professional | None | $134.90 | $138.04 | $173.78 |
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 $120.23 Median $154.88 Typical High $234.42 | Professional | None | $120.23 | $154.88 | $234.42 |
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 $70.79 Median $79.43 Typical High $91.20 | Professional | 52 · Reduced service | $70.79 | $79.43 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $31.62 Typical High $36.31 | Professional | 53 · Discontinued | $28.18 | $31.62 | $36.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $104.71 Median $120.23 Typical High $134.90 | Professional | 54 · Surgery only | $104.71 | $120.23 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.89 Median $23.99 Typical High $26.92 | Professional | 55 · Aftercare only | $20.89 | $23.99 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $15.85 Typical High $18.20 | Professional | 56 · Pre-op care only | $14.13 | $15.85 | $18.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $97.72 Median $112.20 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $97.72 | $112.20 | $125.89 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 Typical Low $104.71 Median $144.54 Typical High $190.55 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 | $104.71 | $144.54 | $190.55 |
Where Alabama sits
The same service costs 3.9 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· 43rd of 51
$178
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.