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 $20.89 Median $1,000.00 Typical High $7,943.28 | Facility | None | $20.89 | $1,000.00 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $20.89 Median $20.89 Typical High $58.88 | Professional | None | $20.89 | $20.89 | $58.88 |
BCBS North Carolina Setting Facility Modifier None Typical Low $181.97 Median $269.15 Typical High $363.08 | Facility | None | $181.97 | $269.15 | $363.08 |
BCBS North Carolina Setting Professional Modifier None Typical Low $28.84 Median $50.12 Typical High $112.20 | Professional | None | $28.84 | $50.12 | $112.20 |
Cigna Setting Facility Modifier None Typical Low $162.18 Median $257.04 Typical High $645.65 | Facility | None | $162.18 | $257.04 | $645.65 |
Cigna Setting Professional Modifier None Typical Low $33.11 Median $83.18 Typical High $134.90 | Professional | None | $33.11 | $83.18 | $134.90 |
Medcost Setting Facility Modifier None Typical Low $25.12 Median $147.91 Typical High $524.81 | Facility | None | $25.12 | $147.91 | $524.81 |
Medcost Setting Professional Modifier None Typical Low $22.91 Median $50.12 Typical High $50.12 | Professional | None | $22.91 | $50.12 | $50.12 |
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 $21.88 Median $30.90 Typical High $109.65 | Professional | None | $21.88 | $30.90 | $109.65 |
10 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 $10.47 Median $10.47 Typical High $18.62 | Professional | 52 · Reduced service | $10.47 | $10.47 | $18.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.17 Median $4.17 Typical High $7.41 | Professional | 53 · Discontinued | $4.17 | $4.17 | $7.41 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $15.85 Median $15.85 Typical High $28.18 | Professional | 54 · Surgery only | $15.85 | $15.85 | $28.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.16 Median $3.16 Typical High $5.62 | Professional | 55 · Aftercare only | $3.16 | $3.16 | $5.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.09 Median $2.09 Typical High $3.72 | Professional | 56 · Pre-op care only | $2.09 | $2.09 | $3.72 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $13.18 Median $25.12 Typical High $28.18 | Professional | 51 · Multiple procedures | $13.18 | $25.12 | $28.18 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $5.37 Median $10.00 Typical High $11.22 | Professional | 80 · Assistant surgeon | $5.37 | $10.00 | $11.22 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $3.72 Median $7.08 Typical High $7.76 | Professional | 81 · Minimal assistant surgeon | $3.72 | $7.08 | $7.76 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $3.72 Median $7.08 Typical High $7.76 | Professional | 82 · Assistant surgeon, no resident | $3.72 | $7.08 | $7.76 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $3.72 Median $7.08 Typical High $7.76 | Professional | AS · PA/NP assist | $3.72 | $7.08 | $7.76 |
Where North Carolina sits
The same service costs 9.1 times more in Tennessee than in Maine. 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· 41st of 51
$50.12
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.