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 $30.90 Median $30.90 Typical High $30.90 | Facility | None | $30.90 | $30.90 | $30.90 |
Aetna Setting Professional Modifier None Typical Low $20.42 Median $30.90 Typical High $54.95 | Professional | None | $20.42 | $30.90 | $54.95 |
Ambetter Setting Professional Modifier None Typical Low $19.05 Median $19.05 Typical High $26.30 | Professional | None | $19.05 | $19.05 | $26.30 |
Anthem BCBS Setting Facility Modifier None Typical Low $15.14 Median $15.14 Typical High $28.84 | Facility | None | $15.14 | $15.14 | $28.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $15.14 Median $15.14 Typical High $37.15 | Professional | None | $15.14 | $15.14 | $37.15 |
CareSource Setting Facility Modifier None Typical Low $52.48 Median $52.48 Typical High $54.95 | Facility | None | $52.48 | $52.48 | $54.95 |
Cigna Setting Professional Modifier None Typical Low $15.14 Median $15.14 Typical High $177.83 | Professional | None | $15.14 | $15.14 | $177.83 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $33.11 Median $117.49 Typical High $2,137.96 | Facility | None | $33.11 | $117.49 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $23.44 Median $30.20 Typical High $54.95 | Professional | None | $23.44 | $30.20 | $54.95 |
United Setting Professional Modifier None Typical Low $10.23 Median $18.20 Typical High $30.20 | Professional | None | $10.23 | $18.20 | $30.20 |
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 $10.23 Median $15.49 Typical High $15.49 | Professional | 52 · Reduced service | $10.23 | $15.49 | $15.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.07 Median $6.31 Typical High $6.31 | Professional | 53 · Discontinued | $4.07 | $6.31 | $6.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $15.49 Median $23.44 Typical High $23.44 | Professional | 54 · Surgery only | $15.49 | $23.44 | $23.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.09 Median $4.68 Typical High $4.68 | Professional | 55 · Aftercare only | $3.09 | $4.68 | $4.68 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.04 Median $3.16 Typical High $3.16 | Professional | 56 · Pre-op care only | $2.04 | $3.16 | $3.16 |
Where Indiana sits
The same service costs 3.1 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
$18.20
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.