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 $147.91 Median $354.81 Typical High $5,623.41 | Facility | None | $147.91 | $354.81 | $5,623.41 |
Aetna Setting Professional Modifier None Typical Low $114.82 Median $169.82 Typical High $234.42 | Professional | None | $114.82 | $169.82 | $234.42 |
Ambetter Setting Professional Modifier None Typical Low $234.42 Median $234.42 Typical High $234.42 | Professional | None | $234.42 | $234.42 | $234.42 |
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 $117.49 Median $173.78 Typical High $245.47 | Professional | None | $117.49 | $173.78 | $245.47 |
CareSource Setting Facility Modifier None Typical Low $138.04 Median $138.04 Typical High $218.78 | Facility | None | $138.04 | $138.04 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $66.07 Median $169.82 Typical High $288.40 | Facility | None | $66.07 | $169.82 | $288.40 |
Cigna Setting Professional Modifier None Typical Low $128.82 Median $181.97 Typical High $288.40 | Professional | None | $128.82 | $181.97 | $288.40 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $199.53 Median $316.23 Typical High $954.99 | Facility | None | $199.53 | $316.23 | $954.99 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $151.36 Median $229.09 Typical High $295.12 | Professional | None | $151.36 | $229.09 | $295.12 |
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 $125.89 Median $181.97 Typical High $302.00 | Professional | None | $125.89 | $181.97 | $302.00 |
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 $57.54 Median $81.28 Typical High $93.33 | Professional | 52 · Reduced service | $57.54 | $81.28 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $32.36 Typical High $37.15 | Professional | 53 · Discontinued | $22.91 | $32.36 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $120.23 Typical High $141.25 | Professional | 54 · Surgery only | $85.11 | $120.23 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $23.99 Typical High $28.18 | Professional | 55 · Aftercare only | $16.98 | $23.99 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $16.22 Typical High $18.62 | Professional | 56 · Pre-op care only | $11.48 | $16.22 | $18.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $112.20 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $79.43 | $112.20 | $131.83 |
Where Indiana sits
The same service costs 3.5 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· 37th of 51
$186
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.