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 $208.93 Median $218.78 Typical High $371.54 | Professional | None | $208.93 | $218.78 | $371.54 |
Ambetter Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $158.49 | Professional | None | $158.49 | $158.49 | $158.49 |
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 $158.49 Median $199.53 Typical High $501.19 | Facility | None | $158.49 | $199.53 | $501.19 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $208.93 Typical High $302.00 | Professional | None | $134.90 | $208.93 | $302.00 |
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 $109.65 Median $204.17 Typical High $338.84 | Professional | None | $109.65 | $204.17 | $338.84 |
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 $107.15 Median $107.15 Typical High $186.21 | Professional | 52 · Reduced service | $107.15 | $107.15 | $186.21 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $43.65 Typical High $74.13 | Professional | 53 · Discontinued | $43.65 | $43.65 | $74.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $162.18 Median $162.18 Typical High $281.84 | Professional | 54 · Surgery only | $162.18 | $162.18 | $281.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $32.36 Typical High $56.23 | Professional | 55 · Aftercare only | $32.36 | $32.36 | $56.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $21.88 Typical High $37.15 | Professional | 56 · Pre-op care only | $21.88 | $21.88 | $37.15 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $151.36 Median $151.36 Typical High $263.03 | Professional | 78 · Unplanned return to OR | $151.36 | $151.36 | $263.03 |
BCBS Alabama Setting Facility Modifier 50 · Both sides Typical Low $977.24 Median $977.24 Typical High $977.24 | Facility | 50 · Both sides | $977.24 | $977.24 | $977.24 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 Typical Low $95.50 Median $128.82 Typical High $186.21 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 | $95.50 | $128.82 | $186.21 |
Where Alabama sits
The same service costs 3.6 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· 27th of 51
$240
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.