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 $151.36 Median $199.53 Typical High $4,265.80 | Facility | None | $151.36 | $199.53 | $4,265.80 |
Aetna Setting Professional Modifier None Typical Low $151.36 Median $199.53 Typical High $323.59 | Professional | None | $151.36 | $199.53 | $323.59 |
Ambetter Setting Professional Modifier None Typical Low $89.13 Median $194.98 Typical High $288.40 | Professional | None | $89.13 | $194.98 | $288.40 |
BCBS North Carolina Setting Facility Modifier None Typical Low $117.49 Median $181.97 Typical High $467.74 | Facility | None | $117.49 | $181.97 | $467.74 |
BCBS North Carolina Setting Professional Modifier None Typical Low $151.36 Median $204.17 Typical High $457.09 | Professional | None | $151.36 | $204.17 | $457.09 |
Cigna Setting Facility Modifier None Typical Low $158.49 Median $245.47 Typical High $524.81 | Facility | None | $158.49 | $245.47 | $524.81 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $204.17 Typical High $436.52 | Professional | None | $158.49 | $204.17 | $436.52 |
Medcost Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $288.40 | Professional | None | $239.88 | $239.88 | $288.40 |
Medcost Setting Facility Modifier None Typical Low $147.91 Median $213.80 Typical High $323.59 | Facility | None | $147.91 | $213.80 | $323.59 |
Medcost Setting Professional Modifier None Typical Low $190.55 Median $239.88 Typical High $281.84 | Professional | None | $190.55 | $239.88 | $281.84 |
United Setting Facility Modifier None Typical Low $478.63 Median $831.76 Typical High $4,365.16 | Facility | None | $478.63 | $831.76 | $4,365.16 |
United Setting Professional Modifier None Typical Low $128.82 Median $190.55 Typical High $416.87 | Professional | None | $128.82 | $190.55 | $416.87 |
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 $75.86 Median $87.10 Typical High $100.00 | Professional | 52 · Reduced service | $75.86 | $87.10 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $34.67 Typical High $39.81 | Professional | 53 · Discontinued | $30.20 | $34.67 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $131.83 Typical High $151.36 | Professional | 54 · Surgery only | $112.20 | $131.83 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $26.30 Typical High $30.20 | Professional | 55 · Aftercare only | $22.39 | $26.30 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $17.38 Typical High $19.95 | Professional | 56 · Pre-op care only | $15.14 | $17.38 | $19.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $123.03 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $104.71 | $123.03 | $141.25 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $69.18 Median $107.15 Typical High $162.18 | Facility | 51 · Multiple procedures | $69.18 | $107.15 | $162.18 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $95.50 Median $120.23 Typical High $151.36 | Professional | 51 · Multiple procedures | $95.50 | $120.23 | $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· 34th of 51
$204
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.