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 $91.20 Median $1,258.93 Typical High $9,772.37 | Facility | None | $91.20 | $1,258.93 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $70.79 Median $104.71 Typical High $190.55 | Professional | None | $70.79 | $104.71 | $190.55 |
Ambetter Setting Professional Modifier None Typical Low $154.88 Median $154.88 Typical High $154.88 | Professional | None | $154.88 | $154.88 | $154.88 |
AmeriHealth Setting Facility Modifier None Typical Low $12,022.64 Median $20,892.96 Typical High $33,113.11 | Facility | None | $12,022.64 | $20,892.96 | $33,113.11 |
AmeriHealth Setting Professional Modifier None Typical Low $144.54 Median $177.83 Typical High $251.19 | Professional | None | $144.54 | $177.83 | $251.19 |
Cigna Setting Facility Modifier None Typical Low $120.23 Median $213.80 Typical High $371.54 | Facility | None | $120.23 | $213.80 | $371.54 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $128.82 Typical High $234.42 | Professional | None | $79.43 | $128.82 | $234.42 |
Emblem Health Setting Professional Modifier None Typical Low $8.13 Median $95.50 Typical High $239.88 | Professional | None | $8.13 | $95.50 | $239.88 |
Horizon BCBS Setting Facility Modifier None Typical Low $194.98 Median $338.84 Typical High $1,513.56 | Facility | None | $194.98 | $338.84 | $1,513.56 |
Horizon BCBS Setting Professional Modifier None Typical Low $100.00 Median $177.83 Typical High $257.04 | Professional | None | $100.00 | $177.83 | $257.04 |
United Setting Facility Modifier None Typical Low $316.23 Median $1,412.54 Typical High $3,801.89 | Facility | None | $316.23 | $1,412.54 | $3,801.89 |
United Setting Professional Modifier None Typical Low $54.95 Median $91.20 Typical High $199.53 | Professional | None | $54.95 | $91.20 | $199.53 |
6 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 $35.48 Median $52.48 Typical High $67.61 | Professional | 52 · Reduced service | $35.48 | $52.48 | $67.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.13 Median $20.89 Typical High $26.92 | Professional | 53 · Discontinued | $14.13 | $20.89 | $26.92 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $52.48 Median $77.62 Typical High $102.33 | Professional | 54 · Surgery only | $52.48 | $77.62 | $102.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.47 Median $15.85 Typical High $20.42 | Professional | 55 · Aftercare only | $10.47 | $15.85 | $20.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.08 Median $10.47 Typical High $13.49 | Professional | 56 · Pre-op care only | $7.08 | $10.47 | $13.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $48.98 Median $72.44 Typical High $95.50 | Professional | 78 · Unplanned return to OR | $48.98 | $72.44 | $95.50 |
Where New Jersey sits
The same service costs 4.1 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.
New Jersey· 44th of 51
$135
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.