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 $83.18 Median $112.20 Typical High $5,248.07 | Facility | None | $83.18 | $112.20 | $5,248.07 |
Aetna Setting Professional Modifier None Typical Low $83.18 Median $112.20 Typical High $158.49 | Professional | None | $83.18 | $112.20 | $158.49 |
BCBS North Carolina Setting Facility Modifier None Typical Low $64.57 Median $97.72 Typical High $131.83 | Facility | None | $64.57 | $97.72 | $131.83 |
BCBS North Carolina Setting Professional Modifier None Typical Low $125.89 Median $199.53 Typical High $316.23 | Professional | None | $125.89 | $199.53 | $316.23 |
Cigna Setting Facility Modifier None Typical Low $95.50 Median $147.91 Typical High $524.81 | Facility | None | $95.50 | $147.91 | $524.81 |
Cigna Setting Professional Modifier None Typical Low $91.20 Median $128.82 Typical High $257.04 | Professional | None | $91.20 | $128.82 | $257.04 |
Medcost Setting Facility Modifier None Typical Low $77.62 Median $112.20 Typical High $181.97 | Facility | None | $77.62 | $112.20 | $181.97 |
Medcost Setting Professional Modifier None Typical Low $107.15 Median $144.54 Typical High $190.55 | Professional | None | $107.15 | $144.54 | $190.55 |
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 $83.18 Median $120.23 Typical High $263.03 | Professional | None | $83.18 | $120.23 | $263.03 |
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 $41.69 Median $54.95 Typical High $58.88 | Professional | 52 · Reduced service | $41.69 | $54.95 | $58.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $21.88 Typical High $23.99 | Professional | 53 · Discontinued | $16.60 | $21.88 | $23.99 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $83.18 Typical High $89.13 | Professional | 54 · Surgery only | $61.66 | $83.18 | $89.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $16.60 Typical High $17.78 | Professional | 55 · Aftercare only | $12.30 | $16.60 | $17.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $10.96 Typical High $11.75 | Professional | 56 · Pre-op care only | $8.32 | $10.96 | $11.75 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $57.54 Median $77.62 Typical High $83.18 | Professional | 78 · Unplanned return to OR | $57.54 | $77.62 | $83.18 |
Ambetter Setting Professional Modifier 58 · Staged procedure Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | 58 · Staged procedure | $223.87 | $223.87 | $223.87 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $36.31 Median $56.23 Typical High $91.20 | Facility | 51 · Multiple procedures | $36.31 | $56.23 | $91.20 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $53.70 Median $79.43 Typical High $154.88 | Professional | 51 · Multiple procedures | $53.70 | $79.43 | $154.88 |
Where North Carolina sits
The same service costs 3.3 times more in Alaska than in Pennsylvania. 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
$166
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.