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 $112.20 Median $169.82 Typical High $1,584.89 | Facility | None | $112.20 | $169.82 | $1,584.89 |
Aetna Setting Professional Modifier None Typical Low $112.20 Median $169.82 Typical High $269.15 | Professional | None | $112.20 | $169.82 | $269.15 |
Ambetter Setting Professional Modifier None Typical Low $72.44 Median $123.03 Typical High $229.09 | Professional | None | $72.44 | $123.03 | $229.09 |
BCBS North Carolina Setting Facility Modifier None Typical Low $102.33 Median $151.36 Typical High $204.17 | Facility | None | $102.33 | $151.36 | $204.17 |
BCBS North Carolina Setting Professional Modifier None Typical Low $109.65 Median $162.18 Typical High $346.74 | Professional | None | $109.65 | $162.18 | $346.74 |
Cigna Setting Facility Modifier None Typical Low $138.04 Median $218.78 Typical High $524.81 | Facility | None | $138.04 | $218.78 | $524.81 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $165.96 Typical High $338.84 | Professional | None | $117.49 | $165.96 | $338.84 |
Medcost Setting Professional Modifier None Typical Low $169.82 Median $169.82 Typical High $234.42 | Professional | None | $169.82 | $169.82 | $234.42 |
Medcost Setting Facility Modifier None Typical Low $123.03 Median $190.55 Typical High $302.00 | Facility | None | $123.03 | $190.55 | $302.00 |
Medcost Setting Professional Modifier None Typical Low $158.49 Median $190.55 Typical High $234.42 | Professional | None | $158.49 | $190.55 | $234.42 |
United Setting Facility Modifier None Typical Low $288.40 Median $501.19 Typical High $2,754.23 | Facility | None | $288.40 | $501.19 | $2,754.23 |
United Setting Professional Modifier None Typical Low $97.72 Median $147.91 Typical High $309.03 | Professional | None | $97.72 | $147.91 | $309.03 |
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 $56.23 Median $70.79 Typical High $83.18 | Professional | 52 · Reduced service | $56.23 | $70.79 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.39 Median $28.18 Typical High $33.88 | Professional | 53 · Discontinued | $22.39 | $28.18 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $107.15 Typical High $125.89 | Professional | 54 · Surgery only | $83.18 | $107.15 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $21.38 Typical High $25.12 | Professional | 55 · Aftercare only | $16.98 | $21.38 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.22 Median $14.13 Typical High $16.98 | Professional | 56 · Pre-op care only | $11.22 | $14.13 | $16.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $77.62 Median $100.00 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $77.62 | $100.00 | $117.49 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $61.66 Median $95.50 Typical High $147.91 | Facility | 51 · Multiple procedures | $61.66 | $95.50 | $147.91 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $77.62 Median $95.50 Typical High $131.83 | Professional | 51 · Multiple procedures | $77.62 | $95.50 | $131.83 |
Where North Carolina sits
The same service costs 3.8 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· 31st of 51
$166
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.