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 $162.18 Median $186.21 Typical High $7,413.10 | Facility | None | $162.18 | $186.21 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $186.21 Typical High $223.87 | Professional | None | $162.18 | $186.21 | $223.87 |
BCBS North Carolina Setting Facility Modifier None Typical Low $79.43 Median $117.49 Typical High $158.49 | Facility | None | $79.43 | $117.49 | $158.49 |
BCBS North Carolina Setting Professional Modifier None Typical Low $223.87 Median $407.38 Typical High $537.03 | Professional | None | $223.87 | $407.38 | $537.03 |
Cigna Setting Facility Modifier None Typical Low $104.71 Median $165.96 Typical High $645.65 | Facility | None | $104.71 | $165.96 | $645.65 |
Cigna Setting Professional Modifier None Typical Low $186.21 Median $234.42 Typical High $446.68 | Professional | None | $186.21 | $234.42 | $446.68 |
Medcost Setting Facility Modifier None Typical Low $93.33 Median $134.90 Typical High $263.03 | Facility | None | $93.33 | $134.90 | $263.03 |
Medcost Setting Professional Modifier None Typical Low $177.83 Median $239.88 Typical High $407.38 | Professional | None | $177.83 | $239.88 | $407.38 |
United Setting Facility Modifier None Typical Low $851.14 Median $1,698.24 Typical High $8,709.64 | Facility | None | $851.14 | $1,698.24 | $8,709.64 |
United Setting Professional Modifier None Typical Low $165.96 Median $229.09 Typical High $446.68 | Professional | None | $165.96 | $229.09 | $446.68 |
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 $81.28 Median $93.33 Typical High $102.33 | Professional | 52 · Reduced service | $81.28 | $93.33 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $37.15 Typical High $40.74 | Professional | 53 · Discontinued | $32.36 | $37.15 | $40.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $120.23 Median $138.04 Typical High $151.36 | Professional | 54 · Surgery only | $120.23 | $138.04 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $27.54 Typical High $30.20 | Professional | 55 · Aftercare only | $24.55 | $27.54 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $18.62 Typical High $20.42 | Professional | 56 · Pre-op care only | $16.22 | $18.62 | $20.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $112.20 Median $128.82 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $112.20 | $128.82 | $141.25 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $42.66 Median $67.61 Typical High $109.65 | Facility | 51 · Multiple procedures | $42.66 | $67.61 | $109.65 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $95.50 Median $162.18 Typical High $263.03 | Professional | 51 · Multiple procedures | $95.50 | $162.18 | $263.03 |
Where North Carolina sits
The same service costs 4.9 times more in Oklahoma 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· 11th of 51
$316
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.