How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $13.80 Median $13.80 Typical High $13.80 | Facility | None | $13.80 | $13.80 | $13.80 |
Aetna Setting Professional Modifier None Typical Low $9.12 Median $13.80 Typical High $13.80 | Professional | None | $9.12 | $13.80 | $13.80 |
Anthem BCBS Setting Facility Modifier None Typical Low $6.61 Median $6.61 Typical High $12.88 | Facility | None | $6.61 | $6.61 | $12.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $6.61 Median $6.61 Typical High $16.60 | Professional | None | $6.61 | $6.61 | $16.60 |
CareSource Setting Facility Modifier None Typical Low $23.44 Median $23.44 Typical High $24.55 | Facility | None | $23.44 | $23.44 | $24.55 |
Cigna Setting Professional Modifier None Typical Low $6.76 Median $6.76 Typical High $85.11 | Professional | None | $6.76 | $6.76 | $85.11 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $14.45 Median $52.48 Typical High $2,137.96 | Facility | None | $14.45 | $52.48 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $10.47 Median $13.49 Typical High $23.99 | Professional | None | $10.47 | $13.49 | $23.99 |
United Setting Professional Modifier None Typical Low $4.57 Median $8.13 Typical High $13.49 | Professional | None | $4.57 | $8.13 | $13.49 |
5 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 $4.57 Median $6.92 Typical High $6.92 | Professional | 52 · Reduced service | $4.57 | $6.92 | $6.92 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.82 Median $2.75 Typical High $2.75 | Professional | 53 · Discontinued | $1.82 | $2.75 | $2.75 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $6.76 Median $10.47 Typical High $10.47 | Professional | 54 · Surgery only | $6.76 | $10.47 | $10.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.35 Median $2.09 Typical High $2.09 | Professional | 55 · Aftercare only | $1.35 | $2.09 | $2.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.91 Median $1.38 Typical High $1.38 | Professional | 56 · Pre-op care only | $0.91 | $1.38 | $1.38 |
Where Indiana sits
The same service costs 3.2 times more in Rhode Island than in New York. 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· 45th of 51
$7.76
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.