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 $190.55 Median $309.03 Typical High $1,584.89 | Facility | None | $190.55 | $309.03 | $1,584.89 |
Aetna Setting Professional Modifier None Typical Low $190.55 Median $309.03 Typical High $489.78 | Professional | None | $190.55 | $309.03 | $489.78 |
Ambetter Setting Professional Modifier None Typical Low $134.90 Median $204.17 Typical High $275.42 | Professional | None | $134.90 | $204.17 | $275.42 |
BCBS North Carolina Setting Facility Modifier None Typical Low $173.78 Median $257.04 Typical High $346.74 | Facility | None | $173.78 | $257.04 | $346.74 |
BCBS North Carolina Setting Professional Modifier None Typical Low $204.17 Median $288.40 Typical High $676.08 | Professional | None | $204.17 | $288.40 | $676.08 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $309.03 Typical High $501.19 | Facility | None | $56.23 | $309.03 | $501.19 |
Cigna Setting Professional Modifier None Typical Low $190.55 Median $269.15 Typical High $616.60 | Professional | None | $190.55 | $269.15 | $616.60 |
Medcost Setting Professional Modifier None Typical Low $288.40 Median $288.40 Typical High $371.54 | Professional | None | $288.40 | $288.40 | $371.54 |
Medcost Setting Facility Modifier None Typical Low $190.55 Median $239.88 Typical High $436.52 | Facility | None | $190.55 | $239.88 | $436.52 |
Medcost Setting Professional Modifier None Typical Low $245.47 Median $295.12 Typical High $371.54 | Professional | None | $245.47 | $295.12 | $371.54 |
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 $177.83 Median $263.03 Typical High $549.54 | Professional | None | $177.83 | $263.03 | $549.54 |
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 $95.50 Median $125.89 Typical High $154.88 | Professional | 52 · Reduced service | $95.50 | $125.89 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $50.12 Typical High $61.66 | Professional | 53 · Discontinued | $38.90 | $50.12 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $190.55 Typical High $229.09 | Professional | 54 · Surgery only | $144.54 | $190.55 | $229.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $38.02 Typical High $46.77 | Professional | 55 · Aftercare only | $28.84 | $38.02 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $25.12 Typical High $30.90 | Professional | 56 · Pre-op care only | $19.05 | $25.12 | $30.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $177.83 Typical High $213.80 | Professional | 78 · Unplanned return to OR | $134.90 | $177.83 | $213.80 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $77.62 Median $120.23 Typical High $218.78 | Facility | 51 · Multiple procedures | $77.62 | $120.23 | $218.78 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $123.03 Median $147.91 Typical High $223.87 | Professional | 51 · Multiple procedures | $123.03 | $147.91 | $223.87 |
Where North Carolina sits
The same service costs 3.7 times more in Alaska than in Maryland. 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· 39th of 51
$282
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.