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 $281.84 Median $295.12 Typical High $5,248.07 | Facility | None | $281.84 | $295.12 | $5,248.07 |
Aetna Setting Professional Modifier None Typical Low $281.84 Median $295.12 Typical High $467.74 | Professional | None | $281.84 | $295.12 | $467.74 |
Ambetter Setting Professional Modifier None Typical Low $338.84 Median $416.87 Typical High $489.78 | Professional | None | $338.84 | $416.87 | $489.78 |
BCBS North Carolina Setting Facility Modifier None Typical Low $79.43 Median $117.49 Typical High $162.18 | Facility | None | $79.43 | $117.49 | $162.18 |
BCBS North Carolina Setting Professional Modifier None Typical Low $316.23 Median $467.74 Typical High $812.83 | Professional | None | $316.23 | $467.74 | $812.83 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $204.17 Typical High $331.13 | Facility | None | $56.23 | $204.17 | $331.13 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $275.42 Typical High $676.08 | Professional | None | $208.93 | $275.42 | $676.08 |
Medcost Setting Professional Modifier None Typical Low $354.81 Median $354.81 Typical High $707.95 | Professional | None | $354.81 | $354.81 | $707.95 |
Medcost Setting Facility Modifier None Typical Low $87.10 Median $128.82 Typical High $436.52 | Facility | None | $87.10 | $128.82 | $436.52 |
Medcost Setting Professional Modifier None Typical Low $223.87 Median $323.59 Typical High $467.74 | Professional | None | $223.87 | $323.59 | $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 $234.42 Median $295.12 Typical High $724.44 | Professional | None | $234.42 | $295.12 | $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 $141.25 Median $147.91 Typical High $158.49 | Professional | 52 · Reduced service | $141.25 | $147.91 | $158.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $58.88 Typical High $63.10 | Professional | 53 · Discontinued | $56.23 | $58.88 | $63.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $223.87 Typical High $234.42 | Professional | 54 · Surgery only | $208.93 | $223.87 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $42.66 Median $44.67 Typical High $46.77 | Professional | 55 · Aftercare only | $42.66 | $44.67 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $29.51 Typical High $31.62 | Professional | 56 · Pre-op care only | $28.18 | $29.51 | $31.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $194.98 Median $208.93 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $194.98 | $208.93 | $218.78 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $40.74 Median $64.57 Typical High $154.88 | Facility | 51 · Multiple procedures | $40.74 | $64.57 | $154.88 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $112.20 Median $162.18 Typical High $371.54 | Professional | 51 · Multiple procedures | $112.20 | $162.18 | $371.54 |
Where North Carolina sits
The same service costs 5.6 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· 19th of 51
$398
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.