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 $104.71 Median $138.04 Typical High $5,248.07 | Facility | None | $104.71 | $138.04 | $5,248.07 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $138.04 Typical High $190.55 | Professional | None | $104.71 | $138.04 | $190.55 |
Ambetter Setting Professional Modifier None Typical Low $109.65 Median $128.82 Typical High $190.55 | Professional | None | $109.65 | $128.82 | $190.55 |
BCBS North Carolina Setting Facility Modifier None Typical Low $47.86 Median $74.13 Typical High $190.55 | Facility | None | $47.86 | $74.13 | $190.55 |
BCBS North Carolina Setting Professional Modifier None Typical Low $147.91 Median $234.42 Typical High $398.11 | Professional | None | $147.91 | $234.42 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $50.12 Typical High $186.21 | Facility | None | $50.12 | $50.12 | $186.21 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $154.88 Typical High $323.59 | Professional | None | $104.71 | $154.88 | $323.59 |
Medcost Setting Facility Modifier None Typical Low $43.65 Median $69.18 Typical High $537.03 | Facility | None | $43.65 | $69.18 | $537.03 |
Medcost Setting Professional Modifier None Typical Low $134.90 Median $173.78 Typical High $234.42 | Professional | None | $134.90 | $173.78 | $234.42 |
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 $104.71 Median $144.54 Typical High $316.23 | Professional | None | $104.71 | $144.54 | $316.23 |
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 $52.48 Median $69.18 Typical High $74.13 | Professional | 52 · Reduced service | $52.48 | $69.18 | $74.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $27.54 Typical High $29.51 | Professional | 53 · Discontinued | $21.38 | $27.54 | $29.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $102.33 Typical High $112.20 | Professional | 54 · Surgery only | $79.43 | $102.33 | $112.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $20.89 Typical High $22.39 | Professional | 55 · Aftercare only | $15.85 | $20.89 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $13.80 Typical High $14.79 | Professional | 56 · Pre-op care only | $10.47 | $13.80 | $14.79 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $95.50 Typical High $104.71 | Professional | 78 · Unplanned return to OR | $74.13 | $95.50 | $104.71 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $21.88 Median $33.88 Typical High $33.88 | Facility | 51 · Multiple procedures | $21.88 | $33.88 | $33.88 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $67.61 Median $100.00 Typical High $194.98 | Professional | 51 · Multiple procedures | $67.61 | $100.00 | $194.98 |
Where North Carolina sits
The same service costs 4.1 times more in Alaska 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· 17th of 51
$186
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.