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 $154.88 Median $2,754.23 Typical High $9,772.37 | Facility | None | $154.88 | $2,754.23 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $125.89 Median $165.96 Typical High $199.53 | Professional | None | $125.89 | $165.96 | $199.53 |
Ambetter Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
AmeriHealth Setting Facility Modifier None Typical Low $295.12 Median $6,309.57 Typical High $12,022.64 | Facility | None | $295.12 | $6,309.57 | $12,022.64 |
AmeriHealth Setting Professional Modifier None Typical Low $151.36 Median $275.42 Typical High $660.69 | Professional | None | $151.36 | $275.42 | $660.69 |
Cigna Setting Facility Modifier None Typical Low $123.03 Median $218.78 Typical High $1,659.59 | Facility | None | $123.03 | $218.78 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $134.90 Typical High $263.03 | Professional | None | $79.43 | $134.90 | $263.03 |
Emblem Health Setting Professional Modifier None Typical Low $177.83 Median $239.88 Typical High $257.04 | Professional | None | $177.83 | $239.88 | $257.04 |
Horizon BCBS Setting Facility Modifier None Typical Low $186.21 Median $338.84 Typical High $1,513.56 | Facility | None | $186.21 | $338.84 | $1,513.56 |
Horizon BCBS Setting Professional Modifier None Typical Low $97.72 Median $181.97 Typical High $354.81 | Professional | None | $97.72 | $181.97 | $354.81 |
United Setting Facility Modifier None Typical Low $309.03 Median $1,380.38 Typical High $3,890.45 | Facility | None | $309.03 | $1,380.38 | $3,890.45 |
United Setting Professional Modifier None Typical Low $50.12 Median $91.20 Typical High $204.17 | Professional | None | $50.12 | $91.20 | $204.17 |
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 $57.54 Median $77.62 Typical High $100.00 | Professional | 52 · Reduced service | $57.54 | $77.62 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $30.90 Typical High $39.81 | Professional | 53 · Discontinued | $22.91 | $30.90 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $117.49 Typical High $151.36 | Professional | 54 · Surgery only | $87.10 | $117.49 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $23.44 Typical High $30.20 | Professional | 55 · Aftercare only | $17.38 | $23.44 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $15.49 Typical High $19.95 | Professional | 56 · Pre-op care only | $11.48 | $15.49 | $19.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $81.28 Median $109.65 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $81.28 | $109.65 | $141.25 |
Where New Jersey sits
The same service costs 3.2 times more in Alaska than in Texas. 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· 39th 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.