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 $61.66 Median $3,548.13 Typical High $10,000.00 | Facility | None | $61.66 | $3,548.13 | $10,000.00 |
Aetna Setting Professional Modifier None Typical Low $52.48 Median $87.10 Typical High $138.04 | Professional | None | $52.48 | $87.10 | $138.04 |
Ambetter Setting Professional Modifier None Typical Low $102.33 Median $107.15 Typical High $131.83 | Professional | None | $102.33 | $107.15 | $131.83 |
AmeriHealth Setting Facility Modifier None Typical Low $1,023.29 Median $33,113.11 Typical High $53,703.18 | Facility | None | $1,023.29 | $33,113.11 | $53,703.18 |
AmeriHealth Setting Professional Modifier None Typical Low $60.26 Median $100.00 Typical High $208.93 | Professional | None | $60.26 | $100.00 | $208.93 |
Cigna Setting Facility Modifier None Typical Low $66.07 Median $275.42 Typical High $389.05 | Facility | None | $66.07 | $275.42 | $389.05 |
Cigna Setting Professional Modifier None Typical Low $41.69 Median $75.86 Typical High $169.82 | Professional | None | $41.69 | $75.86 | $169.82 |
Emblem Health Setting Professional Modifier None Typical Low $8.13 Median $70.79 Typical High $169.82 | Professional | None | $8.13 | $70.79 | $169.82 |
Horizon BCBS Setting Facility Modifier None Typical Low $446.68 Median $741.31 Typical High $933.25 | Facility | None | $446.68 | $741.31 | $933.25 |
Horizon BCBS Setting Professional Modifier None Typical Low $66.07 Median $125.89 Typical High $177.83 | Professional | None | $66.07 | $125.89 | $177.83 |
United Setting Facility Modifier None Typical Low $316.23 Median $1,380.38 Typical High $3,801.89 | Facility | None | $316.23 | $1,380.38 | $3,801.89 |
United Setting Professional Modifier None Typical Low $33.88 Median $64.57 Typical High $141.25 | Professional | None | $33.88 | $64.57 | $141.25 |
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 $26.30 Median $43.65 Typical High $48.98 | Professional | 52 · Reduced service | $26.30 | $43.65 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $17.38 Typical High $19.50 | Professional | 53 · Discontinued | $10.47 | $17.38 | $19.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $39.81 Median $64.57 Typical High $72.44 | Professional | 54 · Surgery only | $39.81 | $64.57 | $72.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $12.88 Typical High $14.45 | Professional | 55 · Aftercare only | $7.94 | $12.88 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $8.71 Typical High $9.77 | Professional | 56 · Pre-op care only | $5.25 | $8.71 | $9.77 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $37.15 Median $60.26 Typical High $67.61 | Professional | 78 · Unplanned return to OR | $37.15 | $60.26 | $67.61 |
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· 50th of 51
$87.10
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.