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 $61.66 Median $112.20 Typical High $5,248.07 | Facility | None | $61.66 | $112.20 | $5,248.07 |
Aetna Setting Professional Modifier None Typical Low $61.66 Median $112.20 Typical High $251.19 | Professional | None | $61.66 | $112.20 | $251.19 |
Ambetter Setting Professional Modifier None Typical Low $208.93 Median $229.09 Typical High $229.09 | Professional | None | $208.93 | $229.09 | $229.09 |
BCBS North Carolina Setting Facility Modifier None Typical Low $47.86 Median $69.18 Typical High $93.33 | Facility | None | $47.86 | $69.18 | $93.33 |
BCBS North Carolina Setting Professional Modifier None Typical Low $77.62 Median $154.88 Typical High $363.08 | Professional | None | $77.62 | $154.88 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $50.12 Typical High $186.21 | Facility | None | $50.12 | $50.12 | $186.21 |
Cigna Setting Professional Modifier None Typical Low $66.07 Median $109.65 Typical High $288.40 | Professional | None | $66.07 | $109.65 | $288.40 |
Medcost Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $165.96 | Professional | None | $151.36 | $151.36 | $165.96 |
Medcost Setting Facility Modifier None Typical Low $43.65 Median $69.18 Typical High $131.83 | Facility | None | $43.65 | $69.18 | $131.83 |
Medcost Setting Professional Modifier None Typical Low $75.86 Median $154.88 Typical High $194.98 | Professional | None | $75.86 | $154.88 | $194.98 |
United Setting Facility Modifier None Typical Low $77.62 Median $165.96 Typical High $1,096.48 | Facility | None | $77.62 | $165.96 | $1,096.48 |
United Setting Professional Modifier None Typical Low $66.07 Median $123.03 Typical High $257.04 | Professional | None | $66.07 | $123.03 | $257.04 |
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 $30.90 Median $53.70 Typical High $56.23 | Professional | 52 · Reduced service | $30.90 | $53.70 | $56.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.59 Median $21.38 Typical High $22.39 | Professional | 53 · Discontinued | $12.59 | $21.38 | $22.39 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $46.77 Median $81.28 Typical High $85.11 | Professional | 54 · Surgery only | $46.77 | $81.28 | $85.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.33 Median $16.22 Typical High $16.98 | Professional | 55 · Aftercare only | $9.33 | $16.22 | $16.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.17 Median $10.72 Typical High $11.22 | Professional | 56 · Pre-op care only | $6.17 | $10.72 | $11.22 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $43.65 Median $75.86 Typical High $79.43 | Professional | 78 · Unplanned return to OR | $43.65 | $75.86 | $79.43 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $21.88 Median $33.88 Typical High $33.88 | Facility | 51 · Multiple procedures | $21.88 | $33.88 | $33.88 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $38.02 Median $77.62 Typical High $104.71 | Professional | 51 · Multiple procedures | $38.02 | $77.62 | $104.71 |
Where North Carolina sits
The same service costs 4.5 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· 37th of 51
$138
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.