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 $144.54 Median $194.98 Typical High $1,584.89 | Facility | None | $144.54 | $194.98 | $1,584.89 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $194.98 Typical High $309.03 | Professional | None | $144.54 | $194.98 | $309.03 |
Ambetter Setting Professional Modifier None Typical Low $85.11 Median $131.83 Typical High $338.84 | Professional | None | $85.11 | $131.83 | $338.84 |
BCBS North Carolina Setting Facility Modifier None Typical Low $112.20 Median $177.83 Typical High $446.68 | Facility | None | $112.20 | $177.83 | $446.68 |
BCBS North Carolina Setting Professional Modifier None Typical Low $138.04 Median $186.21 Typical High $426.58 | Professional | None | $138.04 | $186.21 | $426.58 |
Cigna Setting Facility Modifier None Typical Low $154.88 Median $245.47 Typical High $524.81 | Facility | None | $154.88 | $245.47 | $524.81 |
Cigna Setting Professional Modifier None Typical Low $141.25 Median $186.21 Typical High $407.38 | Professional | None | $141.25 | $186.21 | $407.38 |
Medcost Setting Professional Modifier None Typical Low $208.93 Median $208.93 Typical High $263.03 | Professional | None | $208.93 | $208.93 | $263.03 |
Medcost Setting Facility Modifier None Typical Low $144.54 Median $208.93 Typical High $323.59 | Facility | None | $144.54 | $208.93 | $323.59 |
Medcost Setting Professional Modifier None Typical Low $177.83 Median $218.78 Typical High $269.15 | Professional | None | $177.83 | $218.78 | $269.15 |
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 $123.03 Median $177.83 Typical High $389.05 | Professional | None | $123.03 | $177.83 | $389.05 |
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 $72.44 Median $83.18 Typical High $95.50 | Professional | 52 · Reduced service | $72.44 | $83.18 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $33.11 Typical High $38.90 | Professional | 53 · Discontinued | $28.84 | $33.11 | $38.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $125.89 Typical High $144.54 | Professional | 54 · Surgery only | $107.15 | $125.89 | $144.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $25.12 Typical High $28.84 | Professional | 55 · Aftercare only | $21.38 | $25.12 | $28.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $16.60 Typical High $19.50 | Professional | 56 · Pre-op care only | $14.45 | $16.60 | $19.50 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $117.49 Typical High $134.90 | Professional | 78 · Unplanned return to OR | $100.00 | $117.49 | $134.90 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $67.61 Median $104.71 Typical High $162.18 | Facility | 51 · Multiple procedures | $67.61 | $104.71 | $162.18 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $89.13 Median $109.65 Typical High $151.36 | Professional | 51 · Multiple procedures | $89.13 | $109.65 | $151.36 |
Where North Carolina sits
The same service costs 4.0 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· 29th of 51
$195
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.