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 $52.48 Median $64.57 Typical High $75.86 | Professional | None | $52.48 | $64.57 | $75.86 |
Ambetter Setting Professional Modifier None Typical Low $51.29 Median $60.26 Typical High $60.26 | Professional | None | $51.29 | $60.26 | $60.26 |
BCBS Alabama Setting Facility Modifier None Typical Low $239.88 Median $239.88 Typical High $239.88 | Facility | None | $239.88 | $239.88 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $102.33 Typical High $512.86 | Facility | None | $50.12 | $102.33 | $512.86 |
Cigna Setting Professional Modifier None Typical Low $48.98 Median $48.98 Typical High $69.18 | Professional | None | $48.98 | $48.98 | $69.18 |
United Setting Facility Modifier None Typical Low $100.00 Median $363.08 Typical High $1,380.38 | Facility | None | $100.00 | $363.08 | $1,380.38 |
United Setting Professional Modifier None Typical Low $43.65 Median $53.70 Typical High $85.11 | Professional | None | $43.65 | $53.70 | $85.11 |
8 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 $26.30 Median $28.18 Typical High $31.62 | Professional | 52 · Reduced service | $26.30 | $28.18 | $31.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $11.22 Typical High $12.88 | Professional | 53 · Discontinued | $10.47 | $11.22 | $12.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.90 Median $42.66 Typical High $47.86 | Professional | 54 · Surgery only | $38.90 | $42.66 | $47.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $8.51 Typical High $9.55 | Professional | 55 · Aftercare only | $7.76 | $8.51 | $9.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $5.62 Typical High $6.46 | Professional | 56 · Pre-op care only | $5.25 | $5.62 | $6.46 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $36.31 Median $39.81 Typical High $44.67 | Professional | 78 · Unplanned return to OR | $36.31 | $39.81 | $44.67 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $46.77 Median $48.98 Typical High $54.95 | Professional | 59 · Distinct service | $46.77 | $48.98 | $54.95 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 Typical Low $31.62 Median $43.65 Typical High $72.44 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 | $31.62 | $43.65 | $72.44 |
Where Alabama sits
The same service costs 4.2 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· 46th of 51
$61.66
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.