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 $91.20 Median $144.54 Typical High $7,413.10 | Facility | None | $91.20 | $144.54 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $144.54 Typical High $234.42 | Professional | None | $91.20 | $144.54 | $234.42 |
Ambetter Setting Professional Modifier None Typical Low $117.49 Median $117.49 Typical High $117.49 | Professional | None | $117.49 | $117.49 | $117.49 |
BCBS North Carolina Setting Facility Modifier None Typical Low $81.28 Median $125.89 Typical High $323.59 | Facility | None | $81.28 | $125.89 | $323.59 |
BCBS North Carolina Setting Professional Modifier None Typical Low $97.72 Median $158.49 Typical High $323.59 | Professional | None | $97.72 | $158.49 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $151.36 Typical High $239.88 | Facility | None | $56.23 | $151.36 | $239.88 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $131.83 Typical High $302.00 | Professional | None | $97.72 | $131.83 | $302.00 |
Medcost Setting Professional Modifier None Typical Low $181.97 Median $181.97 Typical High $181.97 | Professional | None | $181.97 | $181.97 | $181.97 |
Medcost Setting Facility Modifier None Typical Low $70.79 Median $102.33 Typical High $245.47 | Facility | None | $70.79 | $102.33 | $245.47 |
Medcost Setting Professional Modifier None Typical Low $125.89 Median $173.78 Typical High $177.83 | Professional | None | $125.89 | $173.78 | $177.83 |
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 $83.18 Median $131.83 Typical High $269.15 | Professional | None | $83.18 | $131.83 | $269.15 |
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 $45.71 Median $63.10 Typical High $72.44 | Professional | 52 · Reduced service | $45.71 | $63.10 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $25.70 Typical High $28.84 | Professional | 53 · Discontinued | $18.20 | $25.70 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $95.50 Typical High $107.15 | Professional | 54 · Surgery only | $67.61 | $95.50 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $19.05 Typical High $21.88 | Professional | 55 · Aftercare only | $13.49 | $19.05 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $12.59 Typical High $14.45 | Professional | 56 · Pre-op care only | $9.12 | $12.59 | $14.45 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $89.13 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $63.10 | $89.13 | $100.00 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $33.11 Median $51.29 Typical High $123.03 | Facility | 51 · Multiple procedures | $33.11 | $51.29 | $123.03 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $63.10 Median $89.13 Typical High $97.72 | Professional | 51 · Multiple procedures | $63.10 | $89.13 | $97.72 |
Where North Carolina sits
The same service costs 3.5 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· 26th of 51
$145
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.