How much rates vary
Facilitymedian $5,495 · 10th to 90th $871 to $11,220Professionalmedian $5,888 · 10th to 90th $617 to $16,596
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 $467.74 Median $5,754.40 Typical High $12,589.25 | Facility | None | $467.74 | $5,754.40 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $467.74 Median $4,786.30 Typical High $8,128.31 | Professional | None | $467.74 | $4,786.30 | $8,128.31 |
Ambetter Setting Professional Modifier None Typical Low $602.56 Median $602.56 Typical High $12,022.64 | Professional | None | $602.56 | $602.56 | $12,022.64 |
BCBS North Carolina Setting Facility Modifier None Typical Low $4,570.88 Median $6,760.83 Typical High $9,120.11 | Facility | None | $4,570.88 | $6,760.83 | $9,120.11 |
BCBS North Carolina Setting Professional Modifier None Typical Low $776.25 Median $5,888.44 Typical High $18,197.01 | Professional | None | $776.25 | $5,888.44 | $18,197.01 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $5,495.41 Typical High $8,709.64 | Facility | None | $602.56 | $5,495.41 | $8,709.64 |
Cigna Setting Professional Modifier None Typical Low $616.60 Median $1,621.81 Typical High $11,481.54 | Professional | None | $616.60 | $1,621.81 | $11,481.54 |
Medcost Setting Professional Modifier None Typical Low $15,488.17 Median $15,488.17 Typical High $15,488.17 | Professional | None | $15,488.17 | $15,488.17 | $15,488.17 |
Medcost Setting Facility Modifier None Typical Low $741.31 Median $4,365.16 Typical High $7,413.10 | Facility | None | $741.31 | $4,365.16 | $7,413.10 |
Medcost Setting Professional Modifier None Typical Low $7,413.10 Median $9,772.37 Typical High $9,772.37 | Professional | None | $7,413.10 | $9,772.37 | $9,772.37 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $4,466.84 Typical High $17,378.01 | Facility | None | $1,380.38 | $4,466.84 | $17,378.01 |
United Setting Professional Modifier None Typical Low $457.09 Median $4,168.69 Typical High $12,022.64 | Professional | None | $457.09 | $4,168.69 | $12,022.64 |
7 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 $229.09 Median $2,398.83 Typical High $2,884.03 | Professional | 52 · Reduced service | $229.09 | $2,398.83 | $2,884.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $954.99 Typical High $1,148.15 | Professional | 53 · Discontinued | $93.33 | $954.99 | $1,148.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $346.74 Median $3,630.78 Typical High $4,265.80 | Professional | 54 · Surgery only | $346.74 | $3,630.78 | $4,265.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $69.18 Median $724.44 Typical High $870.96 | Professional | 55 · Aftercare only | $69.18 | $724.44 | $870.96 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $478.63 Typical High $575.44 | Professional | 56 · Pre-op care only | $46.77 | $478.63 | $575.44 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $323.59 Median $3,388.44 Typical High $3,981.07 | Professional | 78 · Unplanned return to OR | $323.59 | $3,388.44 | $3,981.07 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $4,168.69 Median $4,786.30 Typical High $7,079.46 | Professional | 51 · Multiple procedures | $4,168.69 | $4,786.30 | $7,079.46 |
Where North Carolina sits
The same service costs 5.8 times more in Oklahoma than in Mississippi. 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.
Physician feeFacility fee
OK $20,151MS $3,466
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.