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 $128.82 Median $3,311.31 Typical High $10,000.00 | Facility | None | $128.82 | $3,311.31 | $10,000.00 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $141.25 Typical High $234.42 | Professional | None | $109.65 | $141.25 | $234.42 |
AmeriHealth Setting Facility Modifier None Typical Low $537.03 Median $2,041.74 Typical High $7,079.46 | Facility | None | $537.03 | $2,041.74 | $7,079.46 |
AmeriHealth Setting Professional Modifier None Typical Low $85.11 Median $104.71 Typical High $154.88 | Professional | None | $85.11 | $104.71 | $154.88 |
Cigna Setting Facility Modifier None Typical Low $154.88 Median $275.42 Typical High $1,659.59 | Facility | None | $154.88 | $275.42 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $91.20 Median $162.18 Typical High $295.12 | Professional | None | $91.20 | $162.18 | $295.12 |
Emblem Health Setting Professional Modifier None Typical Low $24.55 Median $165.96 Typical High $269.15 | Professional | None | $24.55 | $165.96 | $269.15 |
Horizon BCBS Setting Facility Modifier None Typical Low $223.87 Median $416.87 Typical High $2,630.27 | Facility | None | $223.87 | $416.87 | $2,630.27 |
Horizon BCBS Setting Professional Modifier None Typical Low $141.25 Median $223.87 Typical High $323.59 | Professional | None | $141.25 | $223.87 | $323.59 |
United Setting Facility Modifier None Typical Low $537.03 Median $1,548.82 Typical High $3,981.07 | Facility | None | $537.03 | $1,548.82 | $3,981.07 |
United Setting Professional Modifier None Typical Low $70.79 Median $112.20 Typical High $251.19 | Professional | None | $70.79 | $112.20 | $251.19 |
7 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 $54.95 Median $70.79 Typical High $83.18 | Professional | 52 · Reduced service | $54.95 | $70.79 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $28.18 Typical High $33.11 | Professional | 53 · Discontinued | $21.88 | $28.18 | $33.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $107.15 Typical High $125.89 | Professional | 54 · Surgery only | $81.28 | $107.15 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $21.38 Typical High $25.12 | Professional | 55 · Aftercare only | $16.60 | $21.38 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $14.13 Typical High $16.60 | Professional | 56 · Pre-op care only | $10.96 | $14.13 | $16.60 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $75.86 Median $100.00 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $75.86 | $100.00 | $117.49 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $199.53 Median $199.53 Typical High $199.53 | Professional | 59 · Distinct service | $199.53 | $199.53 | $199.53 |
Where New Jersey sits
The same service costs 3.9 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· 47th of 51
$166
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.