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 $12.88 Median $12.88 Typical High $12.88 | Facility | None | $12.88 | $12.88 | $12.88 |
Aetna Setting Professional Modifier None Typical Low $8.51 Median $12.88 Typical High $13.80 | Professional | None | $8.51 | $12.88 | $13.80 |
Ambetter Setting Professional Modifier None Typical Low $7.76 Median $7.76 Typical High $30.90 | Professional | None | $7.76 | $7.76 | $30.90 |
Anthem BCBS Setting Facility Modifier None Typical Low $6.31 Median $6.31 Typical High $12.02 | Facility | None | $6.31 | $6.31 | $12.02 |
Anthem BCBS Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $15.49 | Professional | None | $6.31 | $6.31 | $15.49 |
CareSource Setting Facility Modifier None Typical Low $21.88 Median $21.88 Typical High $22.91 | Facility | None | $21.88 | $21.88 | $22.91 |
CareSource Setting Professional Modifier None Typical Low $15.14 Median $18.20 Typical High $21.38 | Professional | None | $15.14 | $18.20 | $21.38 |
Cigna Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $114.82 | Professional | None | $6.31 | $6.31 | $114.82 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $13.80 Median $48.98 Typical High $2,137.96 | Facility | None | $13.80 | $48.98 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $9.77 Median $12.59 Typical High $24.55 | Professional | None | $9.77 | $12.59 | $24.55 |
United Setting Professional Modifier None Typical Low $4.27 Median $7.59 Typical High $12.59 | Professional | None | $4.27 | $7.59 | $12.59 |
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 $4.27 Median $6.46 Typical High $6.46 | Professional | 52 · Reduced service | $4.27 | $6.46 | $6.46 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.70 Median $2.57 Typical High $2.57 | Professional | 53 · Discontinued | $1.70 | $2.57 | $2.57 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $6.46 Median $9.77 Typical High $9.77 | Professional | 54 · Surgery only | $6.46 | $9.77 | $9.77 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.29 Median $1.95 Typical High $1.95 | Professional | 55 · Aftercare only | $1.29 | $1.95 | $1.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.85 Median $1.29 Typical High $1.29 | Professional | 56 · Pre-op care only | $0.85 | $1.29 | $1.29 |
Where Indiana sits
The same service costs 4.5 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· 48th of 51
$7.59
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.