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 $134.90 Median $338.84 Typical High $5,623.41 | Facility | None | $134.90 | $338.84 | $5,623.41 |
Aetna Setting Professional Modifier None Typical Low $102.33 Median $158.49 Typical High $218.78 | Professional | None | $102.33 | $158.49 | $218.78 |
Ambetter Setting Professional Modifier None Typical Low $162.18 Median $177.83 Typical High $177.83 | Professional | None | $162.18 | $177.83 | $177.83 |
Anthem BCBS Setting Facility Modifier None Typical Low $741.31 Median $3,235.94 Typical High $6,309.57 | Facility | None | $741.31 | $3,235.94 | $6,309.57 |
Anthem BCBS Setting Professional Modifier None Typical Low $102.33 Median $162.18 Typical High $229.09 | Professional | None | $102.33 | $162.18 | $229.09 |
CareSource Setting Facility Modifier None Typical Low $123.03 Median $616.60 Typical High $912.01 | Facility | None | $123.03 | $616.60 | $912.01 |
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 $114.82 Median $162.18 Typical High $269.15 | Professional | None | $114.82 | $162.18 | $269.15 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $288.40 Median $524.81 Typical High $2,089.30 | Facility | None | $288.40 | $524.81 | $2,089.30 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $134.90 Median $213.80 Typical High $269.15 | Professional | None | $134.90 | $213.80 | $269.15 |
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 $109.65 Median $165.96 Typical High $281.84 | Professional | None | $109.65 | $165.96 | $281.84 |
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 $51.29 Median $74.13 Typical High $87.10 | Professional | 52 · Reduced service | $51.29 | $74.13 | $87.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $29.51 Typical High $35.48 | Professional | 53 · Discontinued | $20.42 | $29.51 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $109.65 Typical High $131.83 | Professional | 54 · Surgery only | $75.86 | $109.65 | $131.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $21.88 Typical High $26.30 | Professional | 55 · Aftercare only | $15.14 | $21.88 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $14.45 Typical High $17.78 | Professional | 56 · Pre-op care only | $10.23 | $14.45 | $17.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $70.79 Median $102.33 Typical High $123.03 | Professional | 78 · Unplanned return to OR | $70.79 | $102.33 | $123.03 |
Where Indiana sits
The same service costs 3.3 times more in Alaska than in Maryland. 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· 43rd of 51
$166
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.