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 $489.78 Median $933.25 Typical High $1,862.09 | Facility | None | $489.78 | $933.25 | $1,862.09 |
Aetna Setting Professional Modifier None Typical Low $66.07 Median $97.72 Typical High $120.23 | Professional | None | $66.07 | $97.72 | $120.23 |
Ambetter Setting Professional Modifier None Typical Low $85.11 Median $91.20 Typical High $100.00 | Professional | None | $85.11 | $91.20 | $100.00 |
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 $63.10 Median $81.28 Typical High $102.33 | Professional | None | $63.10 | $81.28 | $102.33 |
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 $54.95 Median $85.11 Typical High $117.49 | Professional | None | $54.95 | $85.11 | $117.49 |
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 $32.36 Median $43.65 Typical High $52.48 | Professional | 52 · Reduced service | $32.36 | $43.65 | $52.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $17.38 Typical High $20.89 | Professional | 53 · Discontinued | $13.18 | $17.38 | $20.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $48.98 Median $64.57 Typical High $79.43 | Professional | 54 · Surgery only | $48.98 | $64.57 | $79.43 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $13.18 Typical High $15.85 | Professional | 55 · Aftercare only | $9.77 | $13.18 | $15.85 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $8.71 Typical High $10.47 | Professional | 56 · Pre-op care only | $6.61 | $8.71 | $10.47 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $45.71 Median $60.26 Typical High $74.13 | Professional | 78 · Unplanned return to OR | $45.71 | $60.26 | $74.13 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 Typical Low $39.81 Median $54.95 Typical High $87.10 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 | $39.81 | $54.95 | $87.10 |
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
$100
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.