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 $288.40 Typical High $7,413.10 | Facility | None | $204.17 | $288.40 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $204.17 Median $288.40 Typical High $467.74 | Professional | None | $204.17 | $288.40 | $467.74 |
Ambetter Setting Professional Modifier None Typical Low $309.03 Median $407.38 Typical High $407.38 | Professional | None | $309.03 | $407.38 | $407.38 |
BCBS North Carolina Setting Facility Modifier None Typical Low $169.82 Median $251.19 Typical High $338.84 | Facility | None | $169.82 | $251.19 | $338.84 |
BCBS North Carolina Setting Professional Modifier None Typical Low $204.17 Median $288.40 Typical High $645.65 | Professional | None | $204.17 | $288.40 | $645.65 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $275.42 Typical High $446.68 | Facility | None | $56.23 | $275.42 | $446.68 |
Cigna Setting Professional Modifier None Typical Low $190.55 Median $269.15 Typical High $645.65 | Professional | None | $190.55 | $269.15 | $645.65 |
Medcost Setting Professional Modifier None Typical Low $371.54 Median $371.54 Typical High $380.19 | Professional | None | $371.54 | $371.54 | $380.19 |
Medcost Setting Facility Modifier None Typical Low $199.53 Median $316.23 Typical High $478.63 | Facility | None | $199.53 | $316.23 | $478.63 |
Medcost Setting Professional Modifier None Typical Low $245.47 Median $354.81 Typical High $398.11 | Professional | None | $245.47 | $354.81 | $398.11 |
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 $269.15 Typical High $562.34 | Professional | None | $177.83 | $269.15 | $562.34 |
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 $125.89 Typical High $144.54 | Professional | 52 · Reduced service | $102.33 | $125.89 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $50.12 Typical High $57.54 | Professional | 53 · Discontinued | $40.74 | $50.12 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $151.36 Median $190.55 Typical High $218.78 | Professional | 54 · Surgery only | $151.36 | $190.55 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.20 Median $38.02 Typical High $43.65 | Professional | 55 · Aftercare only | $30.20 | $38.02 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $25.12 Typical High $28.84 | Professional | 56 · Pre-op care only | $20.42 | $25.12 | $28.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $141.25 Median $177.83 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $141.25 | $177.83 | $204.17 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $100.00 Median $158.49 Typical High $239.88 | Facility | 51 · Multiple procedures | $100.00 | $158.49 | $239.88 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $123.03 Median $177.83 Typical High $234.42 | Professional | 51 · Multiple procedures | $123.03 | $177.83 | $234.42 |
Where North Carolina sits
The same service costs 3.9 times more in Alaska than in Texas. 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
$288
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.