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 $138.04 Median $2,754.23 Typical High $9,772.37 | Facility | None | $138.04 | $2,754.23 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $128.82 Median $190.55 Typical High $295.12 | Professional | None | $128.82 | $190.55 | $295.12 |
Ambetter Setting Professional Modifier None Typical Low $190.55 Median $190.55 Typical High $190.55 | Professional | None | $190.55 | $190.55 | $190.55 |
AmeriHealth Setting Facility Modifier None Typical Low $6,025.60 Median $8,912.51 Typical High $14,125.38 | Facility | None | $6,025.60 | $8,912.51 | $14,125.38 |
AmeriHealth Setting Professional Modifier None Typical Low $131.83 Median $239.88 Typical High $933.25 | Professional | None | $131.83 | $239.88 | $933.25 |
Cigna Setting Facility Modifier None Typical Low $194.98 Median $295.12 Typical High $426.58 | Facility | None | $194.98 | $295.12 | $426.58 |
Cigna Setting Professional Modifier None Typical Low $109.65 Median $218.78 Typical High $363.08 | Professional | None | $109.65 | $218.78 | $363.08 |
Emblem Health Setting Professional Modifier None Typical Low $302.00 Median $407.38 Typical High $426.58 | Professional | None | $302.00 | $407.38 | $426.58 |
Horizon BCBS Setting Facility Modifier None Typical Low $338.84 Median $616.60 Typical High $1,513.56 | Facility | None | $338.84 | $616.60 | $1,513.56 |
Horizon BCBS Setting Professional Modifier None Typical Low $141.25 Median $275.42 Typical High $407.38 | Professional | None | $141.25 | $275.42 | $407.38 |
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 $69.18 Median $144.54 Typical High $316.23 | Professional | None | $69.18 | $144.54 | $316.23 |
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 $64.57 Median $93.33 Typical High $107.15 | Professional | 52 · Reduced service | $64.57 | $93.33 | $107.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $37.15 Typical High $42.66 | Professional | 53 · Discontinued | $25.70 | $37.15 | $42.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $138.04 Typical High $158.49 | Professional | 54 · Surgery only | $97.72 | $138.04 | $158.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $28.18 Typical High $31.62 | Professional | 55 · Aftercare only | $19.50 | $28.18 | $31.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $18.62 Typical High $21.38 | Professional | 56 · Pre-op care only | $12.88 | $18.62 | $21.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $128.82 Typical High $147.91 | Professional | 78 · Unplanned return to OR | $91.20 | $128.82 | $147.91 |
Where New Jersey sits
The same service costs 3.4 times more in Alaska than in Maryland. 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· 46th of 51
$209
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.