How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $100.00 Median $144.54 Typical High $1,288.25 | Facility | None | $100.00 | $144.54 | $1,288.25 |
Aetna Setting Professional Modifier None Typical Low $100.00 Median $144.54 Typical High $239.88 | Professional | None | $100.00 | $144.54 | $239.88 |
Ambetter Setting Professional Modifier None Typical Low $64.57 Median $138.04 Typical High $302.00 | Professional | None | $64.57 | $138.04 | $302.00 |
BCBS North Carolina Setting Facility Modifier None Typical Low $87.10 Median $128.82 Typical High $177.83 | Facility | None | $87.10 | $128.82 | $177.83 |
BCBS North Carolina Setting Professional Modifier None Typical Low $97.72 Median $181.97 Typical High $331.13 | Professional | None | $97.72 | $181.97 | $331.13 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $169.82 Typical High $275.42 | Facility | None | $56.23 | $169.82 | $275.42 |
Cigna Setting Professional Modifier None Typical Low $100.00 Median $151.36 Typical High $309.03 | Professional | None | $100.00 | $151.36 | $309.03 |
Medcost Setting Professional Modifier None Typical Low $208.93 Median $208.93 Typical High $229.09 | Professional | None | $208.93 | $208.93 | $229.09 |
Medcost Setting Facility Modifier None Typical Low $120.23 Median $186.21 Typical High $288.40 | Facility | None | $120.23 | $186.21 | $288.40 |
Medcost Setting Professional Modifier None Typical Low $114.82 Median $162.18 Typical High $181.97 | Professional | None | $114.82 | $162.18 | $181.97 |
United Setting Facility Modifier None Typical Low $77.62 Median $165.96 Typical High $1,096.48 | Facility | None | $77.62 | $165.96 | $1,096.48 |
United Setting Professional Modifier None Typical Low $83.18 Median $131.83 Typical High $275.42 | Professional | None | $83.18 | $131.83 | $275.42 |
8 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 $50.12 Median $64.57 Typical High $72.44 | Professional | 52 · Reduced service | $50.12 | $64.57 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $25.70 Typical High $28.84 | Professional | 53 · Discontinued | $19.95 | $25.70 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $97.72 Typical High $109.65 | Professional | 54 · Surgery only | $75.86 | $97.72 | $109.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $19.50 Typical High $21.88 | Professional | 55 · Aftercare only | $15.14 | $19.50 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $12.88 Typical High $14.45 | Professional | 56 · Pre-op care only | $10.00 | $12.88 | $14.45 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $70.79 Median $91.20 Typical High $102.33 | Professional | 78 · Unplanned return to OR | $70.79 | $91.20 | $102.33 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $60.26 Median $93.33 Typical High $141.25 | Facility | 51 · Multiple procedures | $60.26 | $93.33 | $141.25 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $57.54 Median $81.28 Typical High $107.15 | Professional | 51 · Multiple procedures | $57.54 | $81.28 | $107.15 |
Where North Carolina sits
The same service costs 4.1 times more in Alaska than in Kentucky. 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.
North Carolina· 30th of 51
$151
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.