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 $263.03 Median $346.74 Typical High $7,585.78 | Facility | None | $263.03 | $346.74 | $7,585.78 |
Aetna Setting Professional Modifier None Typical Low $263.03 Median $323.59 Typical High $354.81 | Professional | None | $263.03 | $323.59 | $354.81 |
BCBS North Carolina Setting Facility Modifier None Typical Low $147.91 Median $218.78 Typical High $295.12 | Facility | None | $147.91 | $218.78 | $295.12 |
BCBS North Carolina Setting Professional Modifier None Typical Low $288.40 Median $446.68 Typical High $794.33 | Professional | None | $288.40 | $446.68 | $794.33 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $288.40 Typical High $467.74 | Facility | None | $56.23 | $288.40 | $467.74 |
Cigna Setting Professional Modifier None Typical Low $309.03 Median $363.08 Typical High $776.25 | Professional | None | $309.03 | $363.08 | $776.25 |
Medcost Setting Professional Modifier None Typical Low $512.86 Median $512.86 Typical High $616.60 | Professional | None | $512.86 | $512.86 | $616.60 |
Medcost Setting Facility Modifier None Typical Low $138.04 Median $199.53 Typical High $501.19 | Facility | None | $138.04 | $199.53 | $501.19 |
Medcost Setting Professional Modifier None Typical Low $331.13 Median $446.68 Typical High $512.86 | Professional | None | $331.13 | $446.68 | $512.86 |
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 $239.88 Median $338.84 Typical High $724.44 | Professional | None | $239.88 | $338.84 | $724.44 |
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 $128.82 Median $151.36 Typical High $173.78 | Professional | 52 · Reduced service | $128.82 | $151.36 | $173.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $52.48 Median $61.66 Typical High $69.18 | Professional | 53 · Discontinued | $52.48 | $61.66 | $69.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $194.98 Median $229.09 Typical High $257.04 | Professional | 54 · Surgery only | $194.98 | $229.09 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.90 Median $45.71 Typical High $51.29 | Professional | 55 · Aftercare only | $38.90 | $45.71 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.30 Median $30.20 Typical High $34.67 | Professional | 56 · Pre-op care only | $26.30 | $30.20 | $34.67 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $181.97 Median $213.80 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $181.97 | $213.80 | $239.88 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $64.57 Median $100.00 Typical High $245.47 | Facility | 51 · Multiple procedures | $64.57 | $100.00 | $245.47 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $165.96 Median $223.87 Typical High $269.15 | Professional | 51 · Multiple procedures | $165.96 | $223.87 | $269.15 |
Where North Carolina sits
The same service costs 4.0 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· 28th of 51
$363
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.