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 $5,011.87 Typical High $7,244.36 | Facility | None | $162.18 | $5,011.87 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $234.42 Typical High $275.42 | Professional | None | $162.18 | $234.42 | $275.42 |
Ambetter Setting Professional Modifier None Typical Low $181.97 Median $181.97 Typical High $181.97 | Professional | None | $181.97 | $181.97 | $181.97 |
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 $131.83 Median $186.21 Typical High $245.47 | Professional | None | $131.83 | $186.21 | $245.47 |
CareSource Setting Facility Modifier None Typical Low $162.18 Median $162.18 Typical High $346.74 | Facility | None | $162.18 | $162.18 | $346.74 |
CareSource Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $138.04 | Professional | None | $138.04 | $138.04 | $138.04 |
Cigna Setting Facility Modifier None Typical Low $218.78 Median $363.08 Typical High $977.24 | Facility | None | $218.78 | $363.08 | $977.24 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $234.42 Typical High $407.38 | Professional | None | $173.78 | $234.42 | $407.38 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $323.59 Median $676.08 Typical High $4,677.35 | Facility | None | $323.59 | $676.08 | $4,677.35 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $190.55 Median $302.00 Typical High $426.58 | Professional | None | $190.55 | $302.00 | $426.58 |
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 $162.18 Median $234.42 Typical High $380.19 | Professional | None | $162.18 | $234.42 | $380.19 |
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 $79.43 Median $117.49 Typical High $128.82 | Professional | 52 · Reduced service | $79.43 | $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 $120.23 Median $177.83 Typical High $190.55 | Professional | 54 · Surgery only | $120.23 | $177.83 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $35.48 Typical High $38.02 | Professional | 55 · Aftercare only | $23.99 | $35.48 | $38.02 |
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 $112.20 Median $165.96 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $112.20 | $165.96 | $177.83 |
Where Indiana sits
The same service costs 3.6 times more in Alaska 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· 42nd of 51
$219
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.