How much rates vary
Facilitymedian $1,549 · 10th to 90th $275 to $4,074Professionalmedian $263 · 10th to 90th $174 to $550
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 $173.78 Median $257.04 Typical High $4,365.16 | Facility | None | $173.78 | $257.04 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $257.04 Typical High $416.87 | Professional | None | $173.78 | $257.04 | $416.87 |
Ambetter Setting Professional Modifier None Typical Low $134.90 Median $134.90 Typical High $134.90 | Professional | None | $134.90 | $134.90 | $134.90 |
BCBS North Carolina Setting Facility Modifier None Typical Low $1,096.48 Median $1,621.81 Typical High $2,187.76 | Facility | None | $1,096.48 | $1,621.81 | $2,187.76 |
BCBS North Carolina Setting Professional Modifier None Typical Low $181.97 Median $323.59 Typical High $562.34 | Professional | None | $181.97 | $323.59 | $562.34 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $1,778.28 Typical High $2,454.71 | Facility | None | $602.56 | $1,778.28 | $2,454.71 |
Cigna Setting Professional Modifier None Typical Low $194.98 Median $239.88 Typical High $524.81 | Professional | None | $194.98 | $239.88 | $524.81 |
Medcost Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $346.74 | Professional | None | $229.09 | $229.09 | $346.74 |
Medcost Setting Facility Modifier None Typical Low $309.03 Median $812.83 Typical High $2,089.30 | Facility | None | $309.03 | $812.83 | $2,089.30 |
Medcost Setting Professional Modifier None Typical Low $158.49 Median $281.84 Typical High $338.84 | Professional | None | $158.49 | $281.84 | $338.84 |
United Setting Facility Modifier None Typical Low $851.14 Median $1,698.24 Typical High $8,709.64 | Facility | None | $851.14 | $1,698.24 | $8,709.64 |
United Setting Professional Modifier None Typical Low $154.88 Median $223.87 Typical High $478.63 | Professional | None | $154.88 | $223.87 | $478.63 |
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 $87.10 Median $107.15 Typical High $128.82 | Professional | 52 · Reduced service | $87.10 | $107.15 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $42.66 Typical High $51.29 | Professional | 53 · Discontinued | $34.67 | $42.66 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $162.18 Typical High $190.55 | Professional | 54 · Surgery only | $128.82 | $162.18 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $32.36 Typical High $38.90 | Professional | 55 · Aftercare only | $25.70 | $32.36 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $21.38 Typical High $25.70 | Professional | 56 · Pre-op care only | $17.38 | $21.38 | $25.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $151.36 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $120.23 | $151.36 | $177.83 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $263.03 Median $489.78 Typical High $1,445.44 | Facility | 51 · Multiple procedures | $263.03 | $489.78 | $1,445.44 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $79.43 Median $141.25 Typical High $223.87 | Professional | 51 · Multiple procedures | $79.43 | $141.25 | $223.87 |
Where North Carolina sits
The same service costs 9.3 times more in Colorado than in Montana. 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.
Physician feeFacility fee
CO $5,912MT $637
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.