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 $85.11 Median $117.49 Typical High $7,413.10 | Facility | None | $85.11 | $117.49 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $114.82 Typical High $123.03 | Professional | None | $85.11 | $114.82 | $123.03 |
BCBS North Carolina Setting Facility Modifier None Typical Low $57.54 Median $85.11 Typical High $114.82 | Facility | None | $57.54 | $85.11 | $114.82 |
BCBS North Carolina Setting Professional Modifier None Typical Low $128.82 Median $234.42 Typical High $316.23 | Professional | None | $128.82 | $234.42 | $316.23 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $131.83 Typical High $199.53 | Facility | None | $56.23 | $131.83 | $199.53 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $144.54 Typical High $257.04 | Professional | None | $114.82 | $144.54 | $257.04 |
Medcost Setting Professional Modifier None Typical Low $213.80 Median $213.80 Typical High $275.42 | Professional | None | $213.80 | $213.80 | $275.42 |
Medcost Setting Facility Modifier None Typical Low $69.18 Median $102.33 Typical High $229.09 | Facility | None | $69.18 | $102.33 | $229.09 |
Medcost Setting Professional Modifier None Typical Low $117.49 Median $138.04 Typical High $338.84 | Professional | None | $117.49 | $138.04 | $338.84 |
United Setting Facility Modifier None Typical Low $478.63 Median $891.25 Typical High $4,897.79 | Facility | None | $478.63 | $891.25 | $4,897.79 |
United Setting Professional Modifier None Typical Low $81.28 Median $117.49 Typical High $239.88 | Professional | None | $81.28 | $117.49 | $239.88 |
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 $42.66 Median $53.70 Typical High $58.88 | Professional | 52 · Reduced service | $42.66 | $53.70 | $58.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $21.88 Typical High $23.44 | Professional | 53 · Discontinued | $16.98 | $21.88 | $23.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $81.28 Typical High $89.13 | Professional | 54 · Surgery only | $63.10 | $81.28 | $89.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $16.22 Typical High $17.78 | Professional | 55 · Aftercare only | $12.88 | $16.22 | $17.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $10.96 Typical High $11.75 | Professional | 56 · Pre-op care only | $8.51 | $10.96 | $11.75 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $58.88 Median $75.86 Typical High $83.18 | Professional | 78 · Unplanned return to OR | $58.88 | $75.86 | $83.18 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $32.36 Median $51.29 Typical High $81.28 | Facility | 51 · Multiple procedures | $32.36 | $51.29 | $81.28 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $58.88 Median $69.18 Typical High $165.96 | Professional | 51 · Multiple procedures | $58.88 | $69.18 | $165.96 |
Where North Carolina sits
The same service costs 4.0 times more in Alaska than in Florida. 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· 7th of 51
$204
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.