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 $64.57 Median $114.82 Typical High $5,011.87 | Facility | None | $64.57 | $114.82 | $5,011.87 |
Aetna Setting Professional Modifier None Typical Low $56.23 Median $93.33 Typical High $144.54 | Professional | None | $56.23 | $93.33 | $144.54 |
Ambetter Setting Professional Modifier None Typical Low $87.10 Median $104.71 Typical High $144.54 | Professional | None | $87.10 | $104.71 | $144.54 |
Anthem BCBS Setting Facility Modifier None Typical Low $537.03 Median $3,090.30 Typical High $6,165.95 | Facility | None | $537.03 | $3,090.30 | $6,165.95 |
Anthem BCBS Setting Professional Modifier None Typical Low $56.23 Median $102.33 Typical High $123.03 | Professional | None | $56.23 | $102.33 | $123.03 |
CareSource Setting Facility Modifier None Typical Low $69.18 Median $616.60 Typical High $912.01 | Facility | None | $69.18 | $616.60 | $912.01 |
CareSource Setting Professional Modifier None Typical Low $102.33 Median $112.20 Typical High $138.04 | Professional | None | $102.33 | $112.20 | $138.04 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $602.56 | Facility | None | $50.12 | $66.07 | $602.56 |
Cigna Setting Professional Modifier None Typical Low $60.26 Median $89.13 Typical High $154.88 | Professional | None | $60.26 | $89.13 | $154.88 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $177.83 Median $316.23 Typical High $2,089.30 | Facility | None | $177.83 | $316.23 | $2,089.30 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $67.61 Median $120.23 Typical High $158.49 | Professional | None | $67.61 | $120.23 | $158.49 |
United Setting Facility Modifier None Typical Low $109.65 Median $812.83 Typical High $4,168.69 | Facility | None | $109.65 | $812.83 | $4,168.69 |
United Setting Professional Modifier None Typical Low $58.88 Median $95.50 Typical High $162.18 | Professional | None | $58.88 | $95.50 | $162.18 |
7 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 $28.18 Median $43.65 Typical High $51.29 | Professional | 52 · Reduced service | $28.18 | $43.65 | $51.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.22 Median $17.38 Typical High $20.42 | Professional | 53 · Discontinued | $11.22 | $17.38 | $20.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $41.69 Median $64.57 Typical High $77.62 | Professional | 54 · Surgery only | $41.69 | $64.57 | $77.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.32 Median $12.88 Typical High $15.49 | Professional | 55 · Aftercare only | $8.32 | $12.88 | $15.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.62 Median $8.71 Typical High $10.23 | Professional | 56 · Pre-op care only | $5.62 | $8.71 | $10.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $38.90 Median $60.26 Typical High $72.44 | Professional | 78 · Unplanned return to OR | $38.90 | $60.26 | $72.44 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $79.43 Median $93.33 Typical High $154.88 | Professional | 59 · Distinct service | $79.43 | $93.33 | $154.88 |
Where Indiana 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.
Indiana· 32nd of 51
$105
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.