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 $223.87 Median $288.40 Typical High $316.23 | Professional | None | $223.87 | $288.40 | $316.23 |
Ambetter Setting Professional Modifier None Typical Low $346.74 Median $346.74 Typical High $346.74 | Professional | None | $346.74 | $346.74 | $346.74 |
BCBS Alabama Setting Facility Modifier None Typical Low $1,659.59 Median $1,698.24 Typical High $1,698.24 | Facility | None | $1,659.59 | $1,698.24 | $1,698.24 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $741.31 Typical High $1,047.13 | Facility | None | $489.78 | $741.31 | $1,047.13 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $251.19 Typical High $309.03 | Professional | None | $204.17 | $251.19 | $309.03 |
United Setting Facility Modifier None Typical Low $467.74 Median $1,000.00 Typical High $3,162.28 | Facility | None | $467.74 | $1,000.00 | $3,162.28 |
United Setting Professional Modifier None Typical Low $199.53 Median $263.03 Typical High $407.38 | Professional | None | $199.53 | $263.03 | $407.38 |
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 $112.20 Median $138.04 Typical High $158.49 | Professional | 52 · Reduced service | $112.20 | $138.04 | $158.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $56.23 Typical High $63.10 | Professional | 53 · Discontinued | $45.71 | $56.23 | $63.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $169.82 Median $208.93 Typical High $234.42 | Professional | 54 · Surgery only | $169.82 | $208.93 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $41.69 Typical High $47.86 | Professional | 55 · Aftercare only | $33.88 | $41.69 | $47.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.39 Median $28.18 Typical High $31.62 | Professional | 56 · Pre-op care only | $22.39 | $28.18 | $31.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $158.49 Median $194.98 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $158.49 | $194.98 | $218.78 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 Typical Low $213.80 Median $295.12 Typical High $331.13 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 41 | $213.80 | $295.12 | $331.13 |
Where Alabama sits
The same service costs 4.0 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· 40th of 51
$316
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.