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 $131.83 Median $275.42 Typical High $10,232.93 | Facility | None | $131.83 | $275.42 | $10,232.93 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $257.04 Typical High $309.03 | Professional | None | $131.83 | $257.04 | $309.03 |
AmeriHealth Setting Facility Modifier None Typical Low $5,623.41 Median $10,000.00 Typical High $15,488.17 | Facility | None | $5,623.41 | $10,000.00 | $15,488.17 |
Cigna Setting Facility Modifier None Typical Low $114.82 Median $208.93 Typical High $371.54 | Facility | None | $114.82 | $208.93 | $371.54 |
Cigna Setting Professional Modifier None Typical Low $144.54 Median $316.23 Typical High $436.52 | Professional | None | $144.54 | $316.23 | $436.52 |
Emblem Health Setting Professional Modifier None Typical Low $446.68 Median $616.60 Typical High $616.60 | Professional | None | $446.68 | $616.60 | $616.60 |
Horizon BCBS Setting Facility Modifier None Typical Low $165.96 Median $309.03 Typical High $758.58 | Facility | None | $165.96 | $309.03 | $758.58 |
Horizon BCBS Setting Professional Modifier None Typical Low $147.91 Median $323.59 Typical High $575.44 | Professional | None | $147.91 | $323.59 | $575.44 |
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 $112.20 Median $251.19 Typical High $416.87 | Professional | None | $112.20 | $251.19 | $416.87 |
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 $66.07 Median $112.20 Typical High $138.04 | Professional | 52 · Reduced service | $66.07 | $112.20 | $138.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $44.67 Typical High $54.95 | Professional | 53 · Discontinued | $26.30 | $44.67 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $169.82 Typical High $208.93 | Professional | 54 · Surgery only | $100.00 | $169.82 | $208.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $33.88 Typical High $41.69 | Professional | 55 · Aftercare only | $19.95 | $33.88 | $41.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $22.39 Typical High $27.54 | Professional | 56 · Pre-op care only | $13.18 | $22.39 | $27.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $93.33 Median $158.49 Typical High $194.98 | Professional | 78 · Unplanned return to OR | $93.33 | $158.49 | $194.98 |
Where New Jersey sits
The same service costs 3.6 times more in Wisconsin 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· 32nd 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.