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 $125.89 Median $199.53 Typical High $7,413.10 | Facility | None | $125.89 | $199.53 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $125.89 Median $199.53 Typical High $316.23 | Professional | None | $125.89 | $199.53 | $316.23 |
Ambetter Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | None | $173.78 | $173.78 | $173.78 |
BCBS North Carolina Setting Facility Modifier None Typical Low $79.43 Median $117.49 Typical High $158.49 | Facility | None | $79.43 | $117.49 | $158.49 |
BCBS North Carolina Setting Professional Modifier None Typical Low $134.90 Median $208.93 Typical High $436.52 | Professional | None | $134.90 | $208.93 | $436.52 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $194.98 Typical High $316.23 | Facility | None | $56.23 | $194.98 | $316.23 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $181.97 Typical High $416.87 | Professional | None | $138.04 | $181.97 | $416.87 |
Medcost Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $316.23 | Professional | None | $257.04 | $257.04 | $316.23 |
Medcost Setting Facility Modifier None Typical Low $70.79 Median $102.33 Typical High $346.74 | Facility | None | $70.79 | $102.33 | $346.74 |
Medcost Setting Professional Modifier None Typical Low $173.78 Median $245.47 Typical High $269.15 | Professional | None | $173.78 | $245.47 | $269.15 |
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 $117.49 Median $181.97 Typical High $371.54 | Professional | None | $117.49 | $181.97 | $371.54 |
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 $63.10 Median $87.10 Typical High $100.00 | Professional | 52 · Reduced service | $63.10 | $87.10 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $34.67 Typical High $39.81 | Professional | 53 · Discontinued | $25.12 | $34.67 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $131.83 Typical High $151.36 | Professional | 54 · Surgery only | $95.50 | $131.83 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $26.30 Typical High $30.20 | Professional | 55 · Aftercare only | $19.05 | $26.30 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $17.38 Typical High $19.95 | Professional | 56 · Pre-op care only | $12.59 | $17.38 | $19.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $89.13 Median $123.03 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $89.13 | $123.03 | $141.25 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $33.11 Median $51.29 Typical High $173.78 | Facility | 51 · Multiple procedures | $33.11 | $51.29 | $173.78 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $87.10 Median $123.03 Typical High $134.90 | Professional | 51 · Multiple procedures | $87.10 | $123.03 | $134.90 |
Where North Carolina sits
The same service costs 3.5 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· 26th of 51
$200
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.