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 $10.00 Median $10.00 Typical High $10.00 | Facility | None | $10.00 | $10.00 | $10.00 |
Aetna Setting Professional Modifier None Typical Low $6.61 Median $10.00 Typical High $10.00 | Professional | None | $6.61 | $10.00 | $10.00 |
Anthem BCBS Setting Facility Modifier None Typical Low $4.79 Median $4.79 Typical High $9.33 | Facility | None | $4.79 | $4.79 | $9.33 |
Anthem BCBS Setting Professional Modifier None Typical Low $4.79 Median $4.79 Typical High $12.02 | Professional | None | $4.79 | $4.79 | $12.02 |
CareSource Setting Facility Modifier None Typical Low $16.98 Median $16.98 Typical High $17.38 | Facility | None | $16.98 | $16.98 | $17.38 |
Cigna Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $57.54 | Professional | None | $4.90 | $4.90 | $57.54 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $10.47 Median $38.02 Typical High $2,137.96 | Facility | None | $10.47 | $38.02 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $7.59 Median $9.55 Typical High $17.38 | Professional | None | $7.59 | $9.55 | $17.38 |
United Setting Professional Modifier None Typical Low $3.31 Median $5.75 Typical High $9.77 | Professional | None | $3.31 | $5.75 | $9.77 |
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 $3.31 Median $5.01 Typical High $5.01 | Professional | 52 · Reduced service | $3.31 | $5.01 | $5.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.32 Median $2.00 Typical High $2.00 | Professional | 53 · Discontinued | $1.32 | $2.00 | $2.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $4.90 Median $7.59 Typical High $7.59 | Professional | 54 · Surgery only | $4.90 | $7.59 | $7.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.98 Median $1.51 Typical High $1.51 | Professional | 55 · Aftercare only | $0.98 | $1.51 | $1.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.66 Median $1.00 Typical High $1.00 | Professional | 56 · Pre-op care only | $0.66 | $1.00 | $1.00 |
Where Indiana sits
The same service costs 2.9 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· 47th of 51
$5.62
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.