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 $138.04 Median $338.84 Typical High $575.44 | Facility | None | $138.04 | $338.84 | $575.44 |
Aetna Setting Professional Modifier None Typical Low $138.04 Median $269.15 Typical High $416.87 | Professional | None | $138.04 | $269.15 | $416.87 |
Ambetter Setting Professional Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Professional | None | $407.38 | $407.38 | $407.38 |
BCBS North Carolina Setting Facility Modifier None Typical Low $75.86 Median $112.20 Typical High $151.36 | Facility | None | $75.86 | $112.20 | $151.36 |
BCBS North Carolina Setting Professional Modifier None Typical Low $186.21 Median $346.74 Typical High $741.31 | Professional | None | $186.21 | $346.74 | $741.31 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $165.96 Typical High $269.15 | Facility | None | $56.23 | $165.96 | $269.15 |
Cigna Setting Professional Modifier None Typical Low $141.25 Median $295.12 Typical High $512.86 | Professional | None | $141.25 | $295.12 | $512.86 |
Medcost Setting Professional Modifier None Typical Low $416.87 Median $416.87 Typical High $794.33 | Professional | None | $416.87 | $416.87 | $794.33 |
Medcost Setting Facility Modifier None Typical Low $83.18 Median $120.23 Typical High $338.84 | Facility | None | $83.18 | $120.23 | $338.84 |
Medcost Setting Professional Modifier None Typical Low $295.12 Median $346.74 Typical High $467.74 | Professional | None | $295.12 | $346.74 | $467.74 |
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 $125.89 Median $257.04 Typical High $501.19 | Professional | None | $125.89 | $257.04 | $501.19 |
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 $69.18 Median $131.83 Typical High $169.82 | Professional | 52 · Reduced service | $69.18 | $131.83 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $27.54 Median $53.70 Typical High $67.61 | Professional | 53 · Discontinued | $27.54 | $53.70 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $199.53 Typical High $257.04 | Professional | 54 · Surgery only | $102.33 | $199.53 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $39.81 Typical High $51.29 | Professional | 55 · Aftercare only | $20.42 | $39.81 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $26.92 Typical High $33.88 | Professional | 56 · Pre-op care only | $13.80 | $26.92 | $33.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $95.50 Median $186.21 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $95.50 | $186.21 | $239.88 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $38.90 Median $60.26 Typical High $123.03 | Facility | 51 · Multiple procedures | $38.90 | $60.26 | $123.03 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $147.91 Median $190.55 Typical High $354.81 | Professional | 51 · Multiple procedures | $147.91 | $190.55 | $354.81 |
Where North Carolina sits
The same service costs 3.6 times more in Wisconsin 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· 15th of 51
$309
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.