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 $194.98 Median $5,011.87 Typical High $7,244.36 | Facility | None | $194.98 | $5,011.87 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $269.15 Typical High $281.84 | Professional | None | $194.98 | $269.15 | $281.84 |
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 $165.96 Median $229.09 Typical High $338.84 | Professional | None | $165.96 | $229.09 | $338.84 |
CareSource Setting Facility Modifier None Typical Low $204.17 Median $204.17 Typical High $371.54 | Facility | None | $204.17 | $204.17 | $371.54 |
Cigna Setting Facility Modifier None Typical Low $223.87 Median $363.08 Typical High $660.69 | Facility | None | $223.87 | $363.08 | $660.69 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $281.84 Typical High $489.78 | Professional | None | $204.17 | $281.84 | $489.78 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $338.84 Median $549.54 Typical High $1,659.59 | Facility | None | $338.84 | $549.54 | $1,659.59 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $239.88 Median $346.74 Typical High $489.78 | Professional | None | $239.88 | $346.74 | $489.78 |
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 $208.93 Median $309.03 Typical High $537.03 | Professional | None | $208.93 | $309.03 | $537.03 |
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 $97.72 Median $134.90 Typical High $141.25 | Professional | 52 · Reduced service | $97.72 | $134.90 | $141.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $53.70 Typical High $56.23 | Professional | 53 · Discontinued | $38.90 | $53.70 | $56.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $204.17 Typical High $213.80 | Professional | 54 · Surgery only | $147.91 | $204.17 | $213.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $40.74 Typical High $42.66 | Professional | 55 · Aftercare only | $29.51 | $40.74 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $26.92 Typical High $28.18 | Professional | 56 · Pre-op care only | $19.50 | $26.92 | $28.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $190.55 Typical High $199.53 | Professional | 78 · Unplanned return to OR | $138.04 | $190.55 | $199.53 |
Where Indiana sits
The same service costs 3.7 times more in Wisconsin than in Texas. 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
$269
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.