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 $173.78 Median $389.05 Typical High $1,380.38 | Facility | None | $173.78 | $389.05 | $1,380.38 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $257.04 Typical High $338.84 | Professional | None | $131.83 | $257.04 | $338.84 |
Ambetter Setting Professional Modifier None Typical Low $165.96 Median $186.21 Typical High $446.68 | Professional | None | $165.96 | $186.21 | $446.68 |
Anthem BCBS Setting Facility Modifier None Typical Low $616.60 Median $3,090.30 Typical High $6,165.95 | Facility | None | $616.60 | $3,090.30 | $6,165.95 |
Anthem BCBS Setting Professional Modifier None Typical Low $79.43 Median $93.33 Typical High $147.91 | Professional | None | $79.43 | $93.33 | $147.91 |
CareSource Setting Facility Modifier None Typical Low $141.25 Median $141.25 Typical High $218.78 | Facility | None | $141.25 | $141.25 | $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 $144.54 Median $263.03 Typical High $537.03 | Professional | None | $144.54 | $263.03 | $537.03 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $169.82 Median $288.40 Typical High $1,096.48 | Facility | None | $169.82 | $288.40 | $1,096.48 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $165.96 Median $331.13 Typical High $630.96 | Professional | None | $165.96 | $331.13 | $630.96 |
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 $120.23 Median $234.42 Typical High $446.68 | Professional | None | $120.23 | $234.42 | $446.68 |
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 $131.83 Typical High $169.82 | Professional | 52 · Reduced service | $66.07 | $131.83 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $52.48 Typical High $67.61 | Professional | 53 · Discontinued | $26.30 | $52.48 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $194.98 Typical High $251.19 | Professional | 54 · Surgery only | $100.00 | $194.98 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $38.90 Typical High $51.29 | Professional | 55 · Aftercare only | $19.95 | $38.90 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $26.30 Typical High $33.88 | Professional | 56 · Pre-op care only | $13.18 | $26.30 | $33.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $93.33 Median $181.97 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $93.33 | $181.97 | $234.42 |
Where Indiana 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.
Indiana· 48th 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.