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 $4.90 Median $4.90 Typical High $4.90 | Facility | None | $4.90 | $4.90 | $4.90 |
Aetna Setting Professional Modifier None Typical Low $3.24 Median $4.90 Typical High $4.90 | Professional | None | $3.24 | $4.90 | $4.90 |
Ambetter Setting Professional Modifier None Typical Low $19.05 Median $19.05 Typical High $19.05 | Professional | None | $19.05 | $19.05 | $19.05 |
Anthem BCBS Setting Facility Modifier None Typical Low $2.34 Median $2.34 Typical High $4.57 | Facility | None | $2.34 | $2.34 | $4.57 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $5.75 | Professional | None | $2.34 | $2.34 | $5.75 |
CareSource Setting Facility Modifier None Typical Low $8.32 Median $8.32 Typical High $8.51 | Facility | None | $8.32 | $8.32 | $8.51 |
Cigna Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $28.18 | Professional | None | $2.34 | $2.34 | $28.18 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $5.13 Median $18.20 Typical High $2,137.96 | Facility | None | $5.13 | $18.20 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $3.72 Median $4.68 Typical High $8.51 | Professional | None | $3.72 | $4.68 | $8.51 |
United Setting Professional Modifier None Typical Low $1.62 Median $2.82 Typical High $4.79 | Professional | None | $1.62 | $2.82 | $4.79 |
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 $1.58 Median $2.45 Typical High $2.45 | Professional | 52 · Reduced service | $1.58 | $2.45 | $2.45 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.65 Median $0.98 Typical High $0.98 | Professional | 53 · Discontinued | $0.65 | $0.98 | $0.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.40 Median $3.63 Typical High $3.63 | Professional | 54 · Surgery only | $2.40 | $3.63 | $3.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.48 Median $0.72 Typical High $0.72 | Professional | 55 · Aftercare only | $0.48 | $0.72 | $0.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.32 Median $0.49 Typical High $0.49 | Professional | 56 · Pre-op care only | $0.32 | $0.49 | $0.49 |
Where Indiana sits
The same service costs 3.0 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
$2.69
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.