How much rates vary
Facilitymedian $72 · 10th to 90th $45 to $155Professionalmedian $89 · 10th to 90th $58 to $120
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 $44.67 Median $67.61 Typical High $104.71 | Facility | None | $44.67 | $67.61 | $104.71 |
Aetna Setting Professional Modifier None Typical Low $47.86 Median $66.07 Typical High $95.50 | Professional | None | $47.86 | $66.07 | $95.50 |
Ambetter Setting Professional Modifier None Typical Low $63.10 Median $91.20 Typical High $144.54 | Professional | None | $63.10 | $91.20 | $144.54 |
Anthem BCBS Setting Facility Modifier None Typical Low $107.15 Median $107.15 Typical High $213.80 | Facility | None | $107.15 | $107.15 | $213.80 |
Anthem BCBS Setting Professional Modifier None Typical Low $72.44 Median $107.15 Typical High $120.23 | Professional | None | $72.44 | $107.15 | $120.23 |
CareSource Setting Facility Modifier None Typical Low $72.44 Median $72.44 Typical High $83.18 | Facility | None | $72.44 | $72.44 | $83.18 |
CareSource Setting Professional Modifier None Typical Low $102.33 Median $112.20 Typical High $147.91 | Professional | None | $102.33 | $112.20 | $147.91 |
Cigna Setting Facility Modifier None Typical Low $97.72 Median $97.72 Typical High $162.18 | Facility | None | $97.72 | $97.72 | $162.18 |
Cigna Setting Professional Modifier None Typical Low $74.13 Median $95.50 Typical High $141.25 | Professional | None | $74.13 | $95.50 | $141.25 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $165.96 Median $275.42 Typical High $2,089.30 | Facility | None | $165.96 | $275.42 | $2,089.30 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $69.18 Median $97.72 Typical High $154.88 | Professional | None | $69.18 | $97.72 | $154.88 |
United Setting Professional Modifier None Typical Low $66.07 Median $91.20 Typical High $120.23 | Professional | None | $66.07 | $91.20 | $120.23 |
13 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 Facility Modifier 52 · Reduced service Typical Low $29.51 Median $35.48 Typical High $42.66 | Facility | 52 · Reduced service | $29.51 | $35.48 | $42.66 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $8.91 Median $10.72 Typical High $12.88 | Facility | 55 · Aftercare only | $8.91 | $10.72 | $12.88 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $5.89 Median $7.24 Typical High $8.51 | Facility | 56 · Pre-op care only | $5.89 | $7.24 | $8.51 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $29.51 Median $39.81 Typical High $47.86 | Professional | 52 · Reduced service | $29.51 | $39.81 | $47.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.91 Median $12.02 Typical High $14.45 | Professional | 55 · Aftercare only | $8.91 | $12.02 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.89 Median $7.94 Typical High $9.55 | Professional | 56 · Pre-op care only | $5.89 | $7.94 | $9.55 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $74.13 Median $109.65 Typical High $147.91 | Professional | 25 · Same-day visit | $74.13 | $109.65 | $147.91 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $91.20 Median $109.65 Typical High $109.65 | Professional | 57 · Decision for surgery | $91.20 | $109.65 | $109.65 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $87.10 Median $87.10 Typical High $102.33 | Professional | GC · Resident with teaching physician | $87.10 | $87.10 | $102.33 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $138.04 Median $147.91 Typical High $147.91 | Professional | GE · Resident, primary care exception | $138.04 | $147.91 | $147.91 |
Ambetter Setting Professional Modifier GP · Physical therapy plan Typical Low $100.00 Median $100.00 Typical High $100.00 | Professional | GP · Physical therapy plan | $100.00 | $100.00 | $100.00 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $56.23 Median $109.65 Typical High $109.65 | Professional | SA · Nurse practitioner | $56.23 | $109.65 | $109.65 |
Ambetter Setting Professional Modifier U2 · State-defined Typical Low $91.20 Median $91.20 Typical High $91.20 | Professional | U2 · State-defined | $91.20 | $91.20 | $91.20 |
Where Indiana sits
The same service costs 2.3 times more in Alaska than in Alabama. 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
$89.13
AK $170AL $74.13
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.