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 $162.18 Median $3,801.89 Typical High $5,623.41 | Facility | None | $162.18 | $3,801.89 | $5,623.41 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $234.42 Typical High $309.03 | Professional | None | $162.18 | $234.42 | $309.03 |
Anthem BCBS Setting Facility Modifier None Typical Low $741.31 Median $5,370.32 Typical High $9,549.93 | Facility | None | $741.31 | $5,370.32 | $9,549.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $158.49 Median $218.78 Typical High $323.59 | Professional | None | $158.49 | $218.78 | $323.59 |
CareSource Setting Facility Modifier None Typical Low $162.18 Median $162.18 Typical High $407.38 | Facility | None | $162.18 | $162.18 | $407.38 |
Cigna Setting Facility Modifier None Typical Low $245.47 Median $389.05 Typical High $794.33 | Facility | None | $245.47 | $389.05 | $794.33 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $213.80 Typical High $354.81 | Professional | None | $158.49 | $213.80 | $354.81 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $389.05 Median $691.83 Typical High $4,677.35 | Facility | None | $389.05 | $691.83 | $4,677.35 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $199.53 Median $309.03 Typical High $436.52 | Professional | None | $199.53 | $309.03 | $436.52 |
United Setting Facility Modifier None Typical Low $512.86 Median $1,949.84 Typical High $4,677.35 | Facility | None | $512.86 | $1,949.84 | $4,677.35 |
United Setting Professional Modifier None Typical Low $158.49 Median $251.19 Typical High $446.68 | Professional | None | $158.49 | $251.19 | $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 $81.28 Median $117.49 Typical High $128.82 | Professional | 52 · Reduced service | $81.28 | $117.49 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $46.77 Typical High $51.29 | Professional | 53 · Discontinued | $32.36 | $46.77 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $173.78 Typical High $190.55 | Professional | 54 · Surgery only | $123.03 | $173.78 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $34.67 Typical High $38.90 | Professional | 55 · Aftercare only | $24.55 | $34.67 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $23.44 Typical High $25.70 | Professional | 56 · Pre-op care only | $16.22 | $23.44 | $25.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $162.18 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $114.82 | $162.18 | $177.83 |
Where Indiana sits
The same service costs 4.3 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· 43rd of 51
$251
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.