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 $4,365.16 Median $6,918.31 Typical High $12,882.50 | Facility | None | $4,365.16 | $6,918.31 | $12,882.50 |
Aetna Setting Professional Modifier None (both parts) Typical Low $85.11 Median $89.13 Typical High $89.13 | Professional | None (both parts) | $85.11 | $89.13 | $89.13 |
Aetna Setting Professional Modifier 26 · Professional part Typical Low $30.20 Median $32.36 Typical High $32.36 | Professional | 26 · Professional part | $30.20 | $32.36 | $32.36 |
Aetna Setting Professional Modifier TC · Technical part Typical Low $53.70 Median $57.54 Typical High $57.54 | Professional | TC · Technical part | $53.70 | $57.54 | $57.54 |
Cigna Setting Facility Modifier None Typical Low $109.65 Median $109.65 Typical High $131.83 | Facility | None | $109.65 | $109.65 | $131.83 |
Emblem Health Setting Professional Modifier None (both parts) Typical Low $97.72 Median $97.72 Typical High $97.72 | Professional | None (both parts) | $97.72 | $97.72 | $97.72 |
Horizon BCBS Setting Facility Modifier None Typical Low $83.18 Median $125.89 Typical High $173.78 | Facility | None | $83.18 | $125.89 | $173.78 |
Horizon BCBS Setting Professional Modifier None (both parts) Typical Low $75.86 Median $87.10 Typical High $107.15 | Professional | None (both parts) | $75.86 | $87.10 | $107.15 |
Horizon BCBS Setting Professional Modifier 26 · Professional part Typical Low $26.92 Median $30.90 Typical High $38.90 | Professional | 26 · Professional part | $26.92 | $30.90 | $38.90 |
Horizon BCBS Setting Professional Modifier TC · Technical part Typical Low $48.98 Median $56.23 Typical High $69.18 | Professional | TC · Technical part | $48.98 | $56.23 | $69.18 |
United Setting Facility Modifier None Typical Low $72.44 Median $72.44 Typical High $154.88 | Facility | None | $72.44 | $72.44 | $154.88 |
United Setting Professional Modifier None (both parts) Typical Low $67.61 Median $81.28 Typical High $158.49 | Professional | None (both parts) | $67.61 | $81.28 | $158.49 |
United Setting Professional Modifier 26 · Professional part Typical Low $27.54 Median $33.11 Typical High $60.26 | Professional | 26 · Professional part | $27.54 | $33.11 | $60.26 |
United Setting Professional Modifier TC · Technical part Typical Low $38.02 Median $50.12 Typical High $100.00 | Professional | TC · Technical part | $38.02 | $50.12 | $100.00 |
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 $41.69 Median $44.67 Typical High $44.67 | Professional | 52 · Reduced service | $41.69 | $44.67 | $44.67 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $18.20 Typical High $18.20 | Professional | 53 · Discontinued | $16.98 | $18.20 | $18.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $67.61 Typical High $67.61 | Professional | 54 · Surgery only | $63.10 | $67.61 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $13.49 Typical High $13.49 | Professional | 55 · Aftercare only | $12.59 | $13.49 | $13.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $8.91 Typical High $8.91 | Professional | 56 · Pre-op care only | $8.51 | $8.91 | $8.91 |
Where New Jersey sits
The same service costs 4.4 times more in Texas than in New York. 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.
New Jersey· 17th of 51
$87.10
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.