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 $20.42 Median $20.42 Typical High $20.42 | Facility | None | $20.42 | $20.42 | $20.42 |
Aetna Setting Professional Modifier None Typical Low $13.18 Median $20.42 Typical High $20.42 | Professional | None | $13.18 | $20.42 | $20.42 |
Anthem BCBS Setting Facility Modifier None Typical Low $9.77 Median $9.77 Typical High $18.62 | Facility | None | $9.77 | $9.77 | $18.62 |
Anthem BCBS Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $23.99 | Professional | None | $9.77 | $9.77 | $23.99 |
CareSource Setting Facility Modifier None Typical Low $33.88 Median $33.88 Typical High $35.48 | Facility | None | $33.88 | $33.88 | $35.48 |
Cigna Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $120.23 | Professional | None | $9.77 | $9.77 | $120.23 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $21.38 Median $75.86 Typical High $2,137.96 | Facility | None | $21.38 | $75.86 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $15.14 Median $19.50 Typical High $35.48 | Professional | None | $15.14 | $19.50 | $35.48 |
United Setting Professional Modifier None Typical Low $6.61 Median $11.75 Typical High $19.50 | Professional | None | $6.61 | $11.75 | $19.50 |
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 $6.61 Median $10.00 Typical High $10.00 | Professional | 52 · Reduced service | $6.61 | $10.00 | $10.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.63 Median $4.07 Typical High $4.07 | Professional | 53 · Discontinued | $2.63 | $4.07 | $4.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.00 Median $15.14 Typical High $15.14 | Professional | 54 · Surgery only | $10.00 | $15.14 | $15.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.00 Median $3.02 Typical High $3.02 | Professional | 55 · Aftercare only | $2.00 | $3.02 | $3.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.32 Median $2.04 Typical High $2.04 | Professional | 56 · Pre-op care only | $1.32 | $2.04 | $2.04 |
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· 45th of 51
$11.22
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.