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 $562.34 Median $954.99 Typical High $2,398.83 | Facility | None | $562.34 | $954.99 | $2,398.83 |
Aetna Setting Professional Modifier None Typical Low $186.21 Median $239.88 Typical High $302.00 | Professional | None | $186.21 | $239.88 | $302.00 |
Ambetter Setting Professional Modifier None Typical Low $114.82 Median $114.82 Typical High $173.78 | Professional | None | $114.82 | $114.82 | $173.78 |
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 $165.96 Median $204.17 Typical High $501.19 | Facility | None | $165.96 | $204.17 | $501.19 |
Cigna Setting Professional Modifier None Typical Low $181.97 Median $208.93 Typical High $263.03 | Professional | None | $181.97 | $208.93 | $263.03 |
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 $158.49 Median $218.78 Typical High $331.13 | Professional | None | $158.49 | $218.78 | $331.13 |
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 $91.20 Median $114.82 Typical High $131.83 | Professional | 52 · Reduced service | $91.20 | $114.82 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $46.77 Typical High $52.48 | Professional | 53 · Discontinued | $37.15 | $46.77 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $173.78 Typical High $194.98 | Professional | 54 · Surgery only | $138.04 | $173.78 | $194.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $34.67 Typical High $38.90 | Professional | 55 · Aftercare only | $27.54 | $34.67 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $22.91 Typical High $26.30 | Professional | 56 · Pre-op care only | $18.62 | $22.91 | $26.30 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $128.82 Median $162.18 Typical High $181.97 | Professional | 78 · Unplanned return to OR | $128.82 | $162.18 | $181.97 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 Typical Low $123.03 Median $165.96 Typical High $257.04 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 | $123.03 | $165.96 | $257.04 |
Where Alabama sits
The same service costs 3.6 times more in Alaska than in Texas. 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
$263
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.