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 $21.88 Median $21.88 Typical High $21.88 | Facility | None | $21.88 | $21.88 | $21.88 |
Aetna Setting Professional Modifier None Typical Low $9.77 Median $21.88 Typical High $32.36 | Professional | None | $9.77 | $21.88 | $32.36 |
Ambetter Setting Professional Modifier None Typical Low $7.94 Median $7.94 Typical High $18.20 | Professional | None | $7.94 | $7.94 | $18.20 |
BCBS Alabama Setting Facility Modifier None Typical Low $56.23 Median $56.23 Typical High $56.23 | Facility | None | $56.23 | $56.23 | $56.23 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 55 · Aftercare only + 93 · Audio-only telehealth + 99 · Multiple modifiers Typical Low $19.05 Median $38.90 Typical High $50.12 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 55 · Aftercare only + 93 · Audio-only telehealth + 99 · Multiple modifiers | $19.05 | $38.90 | $50.12 |
Cigna Setting Professional Modifier None Typical Low $20.89 Median $20.89 Typical High $69.18 | Professional | None | $20.89 | $20.89 | $69.18 |
United Setting Facility Modifier None Typical Low $54.95 Median $56.23 Typical High $75.86 | Facility | None | $54.95 | $56.23 | $75.86 |
United Setting Professional Modifier None Typical Low $13.49 Median $14.45 Typical High $25.70 | Professional | None | $13.49 | $14.45 | $25.70 |
4 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 $10.96 Median $10.96 Typical High $10.96 | Professional | 52 · Reduced service | $10.96 | $10.96 | $10.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.37 Median $4.37 Typical High $4.37 | Professional | 53 · Discontinued | $4.37 | $4.37 | $4.37 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.31 Median $3.31 Typical High $3.31 | Professional | 55 · Aftercare only | $3.31 | $3.31 | $3.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.19 Median $2.19 Typical High $2.19 | Professional | 56 · Pre-op care only | $2.19 | $2.19 | $2.19 |
Where Alabama sits
The same service costs 6.6 times more in Alabama than in Kansas. 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· 1st of 51
$56.23
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.