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 $162.18 Median $245.47 Typical High $7,413.10 | Facility | None | $162.18 | $245.47 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $245.47 Typical High $398.11 | Professional | None | $162.18 | $245.47 | $398.11 |
Ambetter Setting Professional Modifier None Typical Low $117.49 Median $173.78 Typical High $186.21 | Professional | None | $117.49 | $173.78 | $186.21 |
BCBS North Carolina Setting Facility Modifier None Typical Low $154.88 Median $229.09 Typical High $309.03 | Facility | None | $154.88 | $229.09 | $309.03 |
BCBS North Carolina Setting Professional Modifier None Typical Low $165.96 Median $245.47 Typical High $549.54 | Professional | None | $165.96 | $245.47 | $549.54 |
Cigna Setting Facility Modifier None Typical Low $190.55 Median $302.00 Typical High $575.44 | Facility | None | $190.55 | $302.00 | $575.44 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $223.87 Typical High $512.86 | Professional | None | $158.49 | $223.87 | $512.86 |
Medcost Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $309.03 | Professional | None | $309.03 | $309.03 | $309.03 |
Medcost Setting Facility Modifier None Typical Low $181.97 Median $288.40 Typical High $436.52 | Facility | None | $181.97 | $288.40 | $436.52 |
Medcost Setting Professional Modifier None Typical Low $208.93 Median $302.00 Typical High $338.84 | Professional | None | $208.93 | $302.00 | $338.84 |
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 $144.54 Median $229.09 Typical High $457.09 | Professional | None | $144.54 | $229.09 | $457.09 |
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 $81.28 Median $107.15 Typical High $123.03 | Professional | 52 · Reduced service | $81.28 | $107.15 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $42.66 Typical High $48.98 | Professional | 53 · Discontinued | $32.36 | $42.66 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $162.18 Typical High $186.21 | Professional | 54 · Surgery only | $123.03 | $162.18 | $186.21 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $32.36 Typical High $37.15 | Professional | 55 · Aftercare only | $24.55 | $32.36 | $37.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $21.38 Typical High $24.55 | Professional | 56 · Pre-op care only | $16.22 | $21.38 | $24.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $151.36 Typical High $173.78 | Professional | 78 · Unplanned return to OR | $114.82 | $151.36 | $173.78 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $91.20 Median $144.54 Typical High $218.78 | Facility | 51 · Multiple procedures | $91.20 | $144.54 | $218.78 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $102.33 Median $151.36 Typical High $194.98 | Professional | 51 · Multiple procedures | $102.33 | $151.36 | $194.98 |
Where North Carolina sits
The same service costs 3.4 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
$245
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.