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 $204.17 Median $302.00 Typical High $7,244.36 | Facility | None | $204.17 | $302.00 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $204.17 Median $302.00 Typical High $489.78 | Professional | None | $204.17 | $302.00 | $489.78 |
Ambetter Setting Professional Modifier None Typical Low $147.91 Median $398.11 Typical High $398.11 | Professional | None | $147.91 | $398.11 | $398.11 |
BCBS North Carolina Setting Facility Modifier None Typical Low $446.68 Median $645.65 Typical High $891.25 | Facility | None | $446.68 | $645.65 | $891.25 |
BCBS North Carolina Setting Professional Modifier None Typical Low $199.53 Median $295.12 Typical High $676.08 | Professional | None | $199.53 | $295.12 | $676.08 |
Cigna Setting Facility Modifier None Typical Low $457.09 Median $691.83 Typical High $1,737.80 | Facility | None | $457.09 | $691.83 | $1,737.80 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $257.04 Typical High $645.65 | Professional | None | $173.78 | $257.04 | $645.65 |
Medcost Setting Professional Modifier None Typical Low $354.81 Median $354.81 Typical High $363.08 | Professional | None | $354.81 | $354.81 | $363.08 |
Medcost Setting Facility Modifier None Typical Low $331.13 Median $524.81 Typical High $977.24 | Facility | None | $331.13 | $524.81 | $977.24 |
Medcost Setting Professional Modifier None Typical Low $234.42 Median $371.54 Typical High $416.87 | Professional | None | $234.42 | $371.54 | $416.87 |
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 $177.83 Median $275.42 Typical High $575.44 | Professional | None | $177.83 | $275.42 | $575.44 |
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 $102.33 Median $131.83 Typical High $151.36 | Professional | 52 · Reduced service | $102.33 | $131.83 | $151.36 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $52.48 Typical High $60.26 | Professional | 53 · Discontinued | $40.74 | $52.48 | $60.26 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $199.53 Typical High $229.09 | Professional | 54 · Surgery only | $154.88 | $199.53 | $229.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $39.81 Typical High $45.71 | Professional | 55 · Aftercare only | $30.90 | $39.81 | $45.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $26.30 Typical High $30.20 | Professional | 56 · Pre-op care only | $20.42 | $26.30 | $30.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $144.54 Median $186.21 Typical High $213.80 | Professional | 78 · Unplanned return to OR | $144.54 | $186.21 | $213.80 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $177.83 Median $281.84 Typical High $489.78 | Facility | 51 · Multiple procedures | $177.83 | $281.84 | $489.78 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $117.49 Median $186.21 Typical High $251.19 | Professional | 51 · Multiple procedures | $117.49 | $186.21 | $251.19 |
Where North Carolina sits
The same service costs 3.6 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· 32nd of 51
$302
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.