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 $75.86 Median $100.00 Typical High $162.18 | Facility | None | $75.86 | $100.00 | $162.18 |
Aetna Setting Professional Modifier None Typical Low $70.79 Median $93.33 Typical High $109.65 | Professional | None | $70.79 | $93.33 | $109.65 |
Ambetter Setting Professional Modifier None Typical Low $81.28 Median $114.82 Typical High $138.04 | Professional | None | $81.28 | $114.82 | $138.04 |
Anthem BCBS Setting Facility Modifier None Typical Low $117.49 Median $117.49 Typical High $223.87 | Facility | None | $117.49 | $117.49 | $223.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $87.10 Median $114.82 Typical High $131.83 | Professional | None | $87.10 | $114.82 | $131.83 |
CareSource Setting Facility Modifier None Typical Low $77.62 Median $147.91 Typical High $229.09 | Facility | None | $77.62 | $147.91 | $229.09 |
CareSource Setting Professional Modifier None Typical Low $107.15 Median $117.49 Typical High $154.88 | Professional | None | $107.15 | $117.49 | $154.88 |
Cigna Setting Professional Modifier None Typical Low $72.44 Median $97.72 Typical High $144.54 | Professional | None | $72.44 | $97.72 | $144.54 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $218.78 Median $346.74 Typical High $2,187.76 | Facility | None | $218.78 | $346.74 | $2,187.76 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $74.13 Median $109.65 Typical High $162.18 | Professional | None | $74.13 | $109.65 | $162.18 |
United Setting Professional Modifier None Typical Low $74.13 Median $97.72 Typical High $134.90 | Professional | None | $74.13 | $97.72 | $134.90 |
7 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 $37.15 Median $44.67 Typical High $53.70 | Professional | 52 · Reduced service | $37.15 | $44.67 | $53.70 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.22 Median $13.49 Typical High $15.85 | Professional | 55 · Aftercare only | $11.22 | $13.49 | $15.85 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.41 Median $9.12 Typical High $10.72 | Professional | 56 · Pre-op care only | $7.41 | $9.12 | $10.72 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $97.72 Median $114.82 Typical High $154.88 | Professional | 25 · Same-day visit | $97.72 | $114.82 | $154.88 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $144.54 Median $147.91 Typical High $147.91 | Professional | GC · Resident with teaching physician | $144.54 | $147.91 | $147.91 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $154.88 Median $154.88 Typical High $154.88 | Professional | GE · Resident, primary care exception | $154.88 | $154.88 | $154.88 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $144.54 Median $144.54 Typical High $144.54 | Professional | SA · Nurse practitioner | $144.54 | $144.54 | $144.54 |
Where Indiana sits
The same service costs 2.7 times more in Alaska than in Washington, DC. 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· 34th of 51
$105
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.