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 $144.54 Median $251.19 Typical High $7,244.36 | Facility | None | $144.54 | $251.19 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $173.78 Typical High $213.80 | Professional | None | $120.23 | $173.78 | $213.80 |
Ambetter Setting Professional Modifier None Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | None | $186.21 | $186.21 | $186.21 |
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 $100.00 Median $154.88 Typical High $223.87 | Professional | None | $100.00 | $154.88 | $223.87 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $151.36 Median $234.42 Typical High $346.74 | Professional | 50 · Both sides | $151.36 | $234.42 | $346.74 |
CareSource Setting Facility Modifier None Typical Low $134.90 Median $134.90 Typical High $316.23 | Facility | None | $134.90 | $134.90 | $316.23 |
Cigna Setting Facility Modifier None Typical Low $169.82 Median $302.00 Typical High $933.25 | Facility | None | $169.82 | $302.00 | $933.25 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $190.55 Typical High $346.74 | Professional | None | $138.04 | $190.55 | $346.74 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $302.00 Median $457.09 Typical High $1,659.59 | Facility | None | $302.00 | $457.09 | $1,659.59 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $141.25 Median $234.42 Typical High $363.08 | Professional | None | $141.25 | $234.42 | $363.08 |
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 $204.17 Typical High $354.81 | Professional | None | $125.89 | $204.17 | $354.81 |
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 $60.26 Median $87.10 Typical High $97.72 | Professional | 52 · Reduced service | $60.26 | $87.10 | $97.72 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $34.67 Typical High $39.81 | Professional | 53 · Discontinued | $23.99 | $34.67 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $131.83 Typical High $147.91 | Professional | 54 · Surgery only | $91.20 | $131.83 | $147.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $26.30 Typical High $29.51 | Professional | 55 · Aftercare only | $18.20 | $26.30 | $29.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $17.38 Typical High $19.50 | Professional | 56 · Pre-op care only | $12.02 | $17.38 | $19.50 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $123.03 Typical High $138.04 | Professional | 78 · Unplanned return to OR | $85.11 | $123.03 | $138.04 |
Where Indiana sits
The same service costs 3.5 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· 49th of 51
$182
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.