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 $21.88 Median $21.88 Typical High $21.88 | Facility | None | $21.88 | $21.88 | $21.88 |
Aetna Setting Professional Modifier None Typical Low $14.45 Median $21.88 Typical High $22.39 | Professional | None | $14.45 | $21.88 | $22.39 |
Ambetter Setting Professional Modifier None Typical Low $15.85 Median $15.85 Typical High $15.85 | Professional | None | $15.85 | $15.85 | $15.85 |
Anthem BCBS Setting Facility Modifier None Typical Low $10.72 Median $10.72 Typical High $20.42 | Facility | None | $10.72 | $10.72 | $20.42 |
Anthem BCBS Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $26.30 | Professional | None | $10.72 | $10.72 | $26.30 |
CareSource Setting Facility Modifier None Typical Low $37.15 Median $37.15 Typical High $38.90 | Facility | None | $37.15 | $37.15 | $38.90 |
Cigna Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $144.54 | Professional | None | $10.72 | $10.72 | $144.54 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $22.91 Median $77.62 Typical High $2,137.96 | Facility | None | $22.91 | $77.62 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $16.98 Median $21.88 Typical High $40.74 | Professional | None | $16.98 | $21.88 | $40.74 |
United Setting Professional Modifier None Typical Low $7.24 Median $12.88 Typical High $21.38 | Professional | None | $7.24 | $12.88 | $21.38 |
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 $7.24 Median $10.96 Typical High $10.96 | Professional | 52 · Reduced service | $7.24 | $10.96 | $10.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.88 Median $4.37 Typical High $4.37 | Professional | 53 · Discontinued | $2.88 | $4.37 | $4.37 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.72 Median $16.60 Typical High $16.60 | Professional | 54 · Surgery only | $10.72 | $16.60 | $16.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.19 Median $3.31 Typical High $3.31 | Professional | 55 · Aftercare only | $2.19 | $3.31 | $3.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.45 Median $2.19 Typical High $2.19 | Professional | 56 · Pre-op care only | $1.45 | $2.19 | $2.19 |
Where Indiana sits
The same service costs 3.5 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
$12.59
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.