How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $5.75 Median $5.75 Typical High $6.61 | Facility | None | $5.75 | $5.75 | $6.61 |
Aetna Setting Professional Modifier None Typical Low $5.75 Median $5.75 Typical High $12.59 | Professional | None | $5.75 | $5.75 | $12.59 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $2.88 Median $2.88 Typical High $6.31 | Professional | 52 · Reduced service | $2.88 | $2.88 | $6.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.15 Median $1.15 Typical High $2.45 | Professional | 53 · Discontinued | $1.15 | $1.15 | $2.45 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.85 Median $0.85 Typical High $1.82 | Professional | 55 · Aftercare only | $0.85 | $0.85 | $1.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.56 Median $0.56 Typical High $1.23 | Professional | 56 · Pre-op care only | $0.56 | $0.56 | $1.23 |
AmeriHealth Setting Professional Modifier None Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | None | $10.00 | $10.00 | $10.00 |
Cigna Setting Professional Modifier None Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | None | $9.55 | $9.55 | $9.55 |
Emblem Health Setting Professional Modifier None Typical Low $21.38 Median $26.92 Typical High $26.92 | Professional | None | $21.38 | $26.92 | $26.92 |
Horizon BCBS Setting Professional Modifier None Typical Low $12.88 Median $12.88 Typical High $13.18 | Professional | None | $12.88 | $12.88 | $13.18 |
United Setting Facility Modifier None Typical Low $22.91 Median $22.91 Typical High $26.92 | Facility | None | $22.91 | $22.91 | $26.92 |
United Setting Professional Modifier None Typical Low $10.00 Median $12.30 Typical High $15.14 | Professional | None | $10.00 | $12.30 | $15.14 |
4 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 |
|---|---|---|---|---|---|
AmeriHealth Setting Professional Modifier MV Typical Low $25.12 Median $25.12 Typical High $70.79 | Professional | MV | $25.12 | $25.12 | $70.79 |
AmeriHealth Setting Professional Modifier PP · Ambulance P to P Typical Low $70.79 Median $70.79 Typical High $70.79 | Professional | PP · Ambulance P to P | $70.79 | $70.79 | $70.79 |
AmeriHealth Setting Professional Modifier SM · Second surgical opinion Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | SM · Second surgical opinion | $10.00 | $10.00 | $10.00 |
AmeriHealth Setting Professional Modifier SV · Delivered, not used Typical Low $25.12 Median $25.12 Typical High $60.26 | Professional | SV · Delivered, not used | $25.12 | $25.12 | $60.26 |
Where New Jersey sits
The same service costs 3.0 times more in Montana than in New York. 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· 39th of 51
$11.22
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.