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 $6.92 Median $6.92 Typical High $6.92 | Facility | None | $6.92 | $6.92 | $6.92 |
Aetna Setting Professional Modifier None Typical Low $4.57 Median $6.92 Typical High $6.92 | Professional | None | $4.57 | $6.92 | $6.92 |
Anthem BCBS Setting Facility Modifier None Typical Low $3.39 Median $3.39 Typical High $6.46 | Facility | None | $3.39 | $3.39 | $6.46 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $8.32 | Professional | None | $3.39 | $3.39 | $8.32 |
CareSource Setting Facility Modifier None Typical Low $11.75 Median $11.75 Typical High $12.02 | Facility | None | $11.75 | $11.75 | $12.02 |
Cigna Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $41.69 | Professional | None | $3.39 | $3.39 | $41.69 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $7.24 Median $26.30 Typical High $2,137.96 | Facility | None | $7.24 | $26.30 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $5.25 Median $6.61 Typical High $12.02 | Professional | None | $5.25 | $6.61 | $12.02 |
United Setting Professional Modifier None Typical Low $2.29 Median $4.07 Typical High $6.76 | Professional | None | $2.29 | $4.07 | $6.76 |
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 $2.29 Median $3.47 Typical High $3.47 | Professional | 52 · Reduced service | $2.29 | $3.47 | $3.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.91 Median $1.38 Typical High $1.38 | Professional | 53 · Discontinued | $0.91 | $1.38 | $1.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.39 Median $5.25 Typical High $5.25 | Professional | 54 · Surgery only | $3.39 | $5.25 | $5.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.68 Median $1.05 Typical High $1.05 | Professional | 55 · Aftercare only | $0.68 | $1.05 | $1.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.45 Median $0.69 Typical High $0.69 | Professional | 56 · Pre-op care only | $0.45 | $0.69 | $0.69 |
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· 46th of 51
$3.89
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.