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 $213.80 Median $4,365.16 Typical High $9,772.37 | Facility | None | $213.80 | $4,365.16 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $177.83 Median $223.87 Typical High $389.05 | Professional | None | $177.83 | $223.87 | $389.05 |
Ambetter Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $269.15 | Professional | None | $269.15 | $269.15 | $269.15 |
AmeriHealth Setting Facility Modifier None Typical Low $1,174.90 Median $2,630.27 Typical High $7,943.28 | Facility | None | $1,174.90 | $2,630.27 | $7,943.28 |
AmeriHealth Setting Professional Modifier None Typical Low $147.91 Median $186.21 Typical High $269.15 | Professional | None | $147.91 | $186.21 | $269.15 |
Cigna Setting Facility Modifier None Typical Low $676.08 Median $1,348.96 Typical High $2,187.76 | Facility | None | $676.08 | $1,348.96 | $2,187.76 |
Cigna Setting Professional Modifier None Typical Low $154.88 Median $257.04 Typical High $478.63 | Professional | None | $154.88 | $257.04 | $478.63 |
Emblem Health Setting Professional Modifier None Typical Low $389.05 Median $512.86 Typical High $537.03 | Professional | None | $389.05 | $512.86 | $537.03 |
Horizon BCBS Setting Facility Modifier None Typical Low $1,174.90 Median $2,137.96 Typical High $6,760.83 | Facility | None | $1,174.90 | $2,137.96 | $6,760.83 |
Horizon BCBS Setting Professional Modifier None Typical Low $239.88 Median $363.08 Typical High $489.78 | Professional | None | $239.88 | $363.08 | $489.78 |
United Setting Facility Modifier None Typical Low $707.95 Median $1,995.26 Typical High $5,623.41 | Facility | None | $707.95 | $1,995.26 | $5,623.41 |
United Setting Professional Modifier None Typical Low $123.03 Median $190.55 Typical High $426.58 | Professional | None | $123.03 | $190.55 | $426.58 |
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 $89.13 Median $112.20 Typical High $138.04 | Professional | 52 · Reduced service | $89.13 | $112.20 | $138.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $44.67 Typical High $54.95 | Professional | 53 · Discontinued | $35.48 | $44.67 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $165.96 Typical High $204.17 | Professional | 54 · Surgery only | $131.83 | $165.96 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $33.11 Typical High $40.74 | Professional | 55 · Aftercare only | $26.30 | $33.11 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $22.39 Typical High $27.54 | Professional | 56 · Pre-op care only | $17.78 | $22.39 | $27.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $123.03 Median $154.88 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $123.03 | $154.88 | $190.55 |
Where New Jersey sits
The same service costs 4.8 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· 49th of 51
$275
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.