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 $112.20 Median $112.20 Typical High $112.20 | Facility | None | $112.20 | $112.20 | $112.20 |
Aetna Setting Professional Modifier None Typical Low $60.26 Median $112.20 Typical High $112.20 | Professional | None | $60.26 | $112.20 | $112.20 |
Ambetter Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $125.89 | Professional | None | $120.23 | $120.23 | $125.89 |
Cigna Setting Facility Modifier None Typical Low $67.61 Median $67.61 Typical High $72.44 | Facility | None | $67.61 | $67.61 | $72.44 |
Cigna Setting Professional Modifier None Typical Low $50.12 Median $50.12 Typical High $67.61 | Professional | None | $50.12 | $50.12 | $67.61 |
United Setting Facility Modifier None Typical Low $67.61 Median $117.49 Typical High $138.04 | Facility | None | $67.61 | $117.49 | $138.04 |
United Setting Professional Modifier None Typical Low $33.88 Median $54.95 Typical High $72.44 | Professional | None | $33.88 | $54.95 | $72.44 |
5 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 $34.67 Median $56.23 Typical High $56.23 | Professional | 52 · Reduced service | $34.67 | $56.23 | $56.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.13 Median $22.39 Typical High $22.39 | Professional | 53 · Discontinued | $14.13 | $22.39 | $22.39 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.47 Median $16.60 Typical High $16.60 | Professional | 55 · Aftercare only | $10.47 | $16.60 | $16.60 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.92 Median $11.22 Typical High $11.22 | Professional | 56 · Pre-op care only | $6.92 | $11.22 | $11.22 |
BCBS Alabama Setting Professional Modifier 12 + 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 32 · Mandated service + 55 · Aftercare only + 99 · Multiple modifiers Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | 12 + 21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 32 · Mandated service + 55 · Aftercare only + 99 · Multiple modifiers | $83.18 | $83.18 | $83.18 |
Where Alabama sits
The same service costs 4.1 times more in Hawaii than in Delaware. 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· 45th of 51
$58.88
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.