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 $177.83 Median $2,089.30 Typical High $9,772.37 | Facility | None | $177.83 | $2,089.30 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $234.42 Typical High $363.08 | Professional | None | $162.18 | $234.42 | $363.08 |
Ambetter Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $467.74 | Professional | None | $257.04 | $257.04 | $467.74 |
AmeriHealth Setting Facility Modifier None Typical Low $8,912.51 Median $14,791.08 Typical High $21,379.62 | Facility | None | $8,912.51 | $14,791.08 | $21,379.62 |
AmeriHealth Setting Professional Modifier None Typical Low $138.04 Median $186.21 Typical High $954.99 | Professional | None | $138.04 | $186.21 | $954.99 |
Cigna Setting Facility Modifier None Typical Low $204.17 Median $331.13 Typical High $478.63 | Facility | None | $204.17 | $331.13 | $478.63 |
Cigna Setting Professional Modifier None Typical Low $151.36 Median $269.15 Typical High $457.09 | Professional | None | $151.36 | $269.15 | $457.09 |
Emblem Health Setting Professional Modifier None Typical Low $354.81 Median $478.63 Typical High $512.86 | Professional | None | $354.81 | $478.63 | $512.86 |
Horizon BCBS Setting Facility Modifier None Typical Low $363.08 Median $645.65 Typical High $1,513.56 | Facility | None | $363.08 | $645.65 | $1,513.56 |
Horizon BCBS Setting Professional Modifier None Typical Low $194.98 Median $346.74 Typical High $489.78 | Professional | None | $194.98 | $346.74 | $489.78 |
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 $93.33 Median $181.97 Typical High $398.11 | Professional | None | $93.33 | $181.97 | $398.11 |
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 $81.28 Median $117.49 Typical High $128.82 | Professional | 52 · Reduced service | $81.28 | $117.49 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $46.77 Typical High $51.29 | Professional | 53 · Discontinued | $32.36 | $46.77 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $173.78 Typical High $194.98 | Professional | 54 · Surgery only | $123.03 | $173.78 | $194.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $34.67 Typical High $38.90 | Professional | 55 · Aftercare only | $24.55 | $34.67 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $23.44 Typical High $25.70 | Professional | 56 · Pre-op care only | $16.22 | $23.44 | $25.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $162.18 Typical High $181.97 | Professional | 78 · Unplanned return to OR | $114.82 | $162.18 | $181.97 |
Where New Jersey sits
The same service costs 3.7 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· 44th of 51
$257
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.