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 $181.97 Median $213.80 Typical High $7,244.36 | Facility | None | $181.97 | $213.80 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $181.97 Median $204.17 Typical High $251.19 | Professional | None | $181.97 | $204.17 | $251.19 |
BCBS North Carolina Setting Facility Modifier None Typical Low $1,148.15 Median $1,737.80 Typical High $4,570.88 | Facility | None | $1,148.15 | $1,737.80 | $4,570.88 |
BCBS North Carolina Setting Professional Modifier None Typical Low $257.04 Median $426.58 Typical High $630.96 | Professional | None | $257.04 | $426.58 | $630.96 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $2,290.87 Typical High $3,388.44 | Facility | None | $602.56 | $2,290.87 | $3,388.44 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $263.03 Typical High $512.86 | Professional | None | $208.93 | $263.03 | $512.86 |
Medcost Setting Facility Modifier None Typical Low $245.47 Median $954.99 Typical High $2,511.89 | Facility | None | $245.47 | $954.99 | $2,511.89 |
Medcost Setting Professional Modifier None Typical Low $208.93 Median $275.42 Typical High $416.87 | Professional | None | $208.93 | $275.42 | $416.87 |
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 $181.97 Median $257.04 Typical High $501.19 | Professional | None | $181.97 | $257.04 | $501.19 |
9 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 $89.13 Median $102.33 Typical High $114.82 | Professional | 52 · Reduced service | $89.13 | $102.33 | $114.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $36.31 Median $41.69 Typical High $45.71 | Professional | 53 · Discontinued | $36.31 | $41.69 | $45.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $154.88 Typical High $169.82 | Professional | 54 · Surgery only | $134.90 | $154.88 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $30.90 Typical High $33.88 | Professional | 55 · Aftercare only | $26.92 | $30.90 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $20.42 Typical High $22.91 | Professional | 56 · Pre-op care only | $18.20 | $20.42 | $22.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $144.54 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $125.89 | $144.54 | $158.49 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | KX · Policy requirements met | $416.87 | $416.87 | $416.87 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $263.03 Median $489.78 Typical High $1,258.93 | Facility | 51 · Multiple procedures | $263.03 | $489.78 | $1,258.93 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $117.49 Median $194.98 Typical High $295.12 | Professional | 51 · Multiple procedures | $117.49 | $194.98 | $295.12 |
Where North Carolina sits
The same service costs 5.9 times more in Oklahoma than in Utah. 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· 9th 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.