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 $4.57 Median $4.57 Typical High $4.57 | Facility | None | $4.57 | $4.57 | $4.57 |
Aetna Setting Professional Modifier None Typical Low $3.02 Median $4.57 Typical High $4.57 | Professional | None | $3.02 | $4.57 | $4.57 |
Anthem BCBS Setting Facility Modifier None Typical Low $2.24 Median $2.24 Typical High $4.27 | Facility | None | $2.24 | $2.24 | $4.27 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $5.50 | Professional | None | $2.24 | $2.24 | $5.50 |
CareSource Setting Facility Modifier None Typical Low $7.76 Median $7.76 Typical High $8.13 | Facility | None | $7.76 | $7.76 | $8.13 |
Cigna Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $32.36 | Professional | None | $2.24 | $2.24 | $32.36 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $4.90 Median $17.38 Typical High $2,137.96 | Facility | None | $4.90 | $17.38 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $3.47 Median $4.47 Typical High $7.94 | Professional | None | $3.47 | $4.47 | $7.94 |
United Setting Professional Modifier None Typical Low $1.51 Median $2.69 Typical High $4.47 | Professional | None | $1.51 | $2.69 | $4.47 |
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 $1.51 Median $2.29 Typical High $2.29 | Professional | 52 · Reduced service | $1.51 | $2.29 | $2.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.62 Median $0.91 Typical High $0.91 | Professional | 53 · Discontinued | $0.62 | $0.91 | $0.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.29 Median $3.47 Typical High $3.47 | Professional | 54 · Surgery only | $2.29 | $3.47 | $3.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.45 Median $0.69 Typical High $0.69 | Professional | 55 · Aftercare only | $0.45 | $0.69 | $0.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.30 Median $0.46 Typical High $0.46 | Professional | 56 · Pre-op care only | $0.30 | $0.46 | $0.46 |
Where Indiana sits
The same service costs 3.8 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
$2.57
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.