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 $239.88 Median $3,467.37 Typical High $10,232.93 | Facility | None | $239.88 | $3,467.37 | $10,232.93 |
Aetna Setting Professional Modifier None Typical Low $218.78 Median $269.15 Typical High $426.58 | Professional | None | $218.78 | $269.15 | $426.58 |
Cigna Setting Facility Modifier None Typical Low $251.19 Median $446.68 Typical High $1,659.59 | Facility | None | $251.19 | $446.68 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $169.82 Median $309.03 Typical High $549.54 | Professional | None | $169.82 | $309.03 | $549.54 |
Emblem Health Setting Professional Modifier None Typical Low $389.05 Median $524.81 Typical High $562.34 | Professional | None | $389.05 | $524.81 | $562.34 |
Horizon BCBS Setting Facility Modifier None Typical Low $363.08 Median $691.83 Typical High $1,513.56 | Facility | None | $363.08 | $691.83 | $1,513.56 |
Horizon BCBS Setting Professional Modifier None Typical Low $269.15 Median $407.38 Typical High $660.69 | Professional | None | $269.15 | $407.38 | $660.69 |
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 $128.82 Median $199.53 Typical High $467.74 | Professional | None | $128.82 | $199.53 | $467.74 |
8 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 $109.65 Median $134.90 Typical High $147.91 | Professional | 52 · Reduced service | $109.65 | $134.90 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $53.70 Typical High $58.88 | Professional | 53 · Discontinued | $43.65 | $53.70 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $162.18 Median $199.53 Typical High $223.87 | Professional | 54 · Surgery only | $162.18 | $199.53 | $223.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $39.81 Typical High $44.67 | Professional | 55 · Aftercare only | $32.36 | $39.81 | $44.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $26.92 Typical High $29.51 | Professional | 56 · Pre-op care only | $21.88 | $26.92 | $29.51 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $151.36 Median $186.21 Typical High $208.93 | Professional | 78 · Unplanned return to OR | $151.36 | $186.21 | $208.93 |
AmeriHealth Setting Facility Modifier 58 · Staged procedure Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Facility | 58 · Staged procedure | $2,089.30 | $2,089.30 | $2,089.30 |
AmeriHealth Setting Professional Modifier 58 · Staged procedure Typical Low $812.83 Median $812.83 Typical High $812.83 | Professional | 58 · Staged procedure | $812.83 | $812.83 | $812.83 |
Where New Jersey sits
The same service costs 4.7 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· 47th of 51
$295
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.