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 $109.65 Median $181.97 Typical High $2,630.27 | Facility | None | $109.65 | $181.97 | $2,630.27 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $154.88 Typical High $245.47 | Professional | None | $109.65 | $154.88 | $245.47 |
Ambetter Setting Professional Modifier None Typical Low $102.33 Median $208.93 Typical High $213.80 | Professional | None | $102.33 | $208.93 | $213.80 |
BCBS North Carolina Setting Facility Modifier None Typical Low $66.07 Median $102.33 Typical High $263.03 | Facility | None | $66.07 | $102.33 | $263.03 |
BCBS North Carolina Setting Professional Modifier None Typical Low $141.25 Median $223.87 Typical High $363.08 | Professional | None | $141.25 | $223.87 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $131.83 Median $204.17 Typical High $524.81 | Facility | None | $131.83 | $204.17 | $524.81 |
Cigna Setting Professional Modifier None Typical Low $112.20 Median $162.18 Typical High $323.59 | Professional | None | $112.20 | $162.18 | $323.59 |
Medcost Setting Facility Modifier None Typical Low $77.62 Median $112.20 Typical High $218.78 | Facility | None | $77.62 | $112.20 | $218.78 |
Medcost Setting Professional Modifier None Typical Low $154.88 Median $190.55 Typical High $302.00 | Professional | None | $154.88 | $190.55 | $302.00 |
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 $102.33 Median $154.88 Typical High $331.13 | Professional | None | $102.33 | $154.88 | $331.13 |
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 $54.95 Median $63.10 Typical High $91.20 | Professional | 52 · Reduced service | $54.95 | $63.10 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $25.12 Typical High $37.15 | Professional | 53 · Discontinued | $21.88 | $25.12 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $95.50 Typical High $138.04 | Professional | 54 · Surgery only | $81.28 | $95.50 | $138.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $19.05 Typical High $27.54 | Professional | 55 · Aftercare only | $16.60 | $19.05 | $27.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $12.59 Typical High $18.20 | Professional | 56 · Pre-op care only | $10.96 | $12.59 | $18.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $75.86 Median $89.13 Typical High $128.82 | Professional | 78 · Unplanned return to OR | $75.86 | $89.13 | $128.82 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $36.31 Median $56.23 Typical High $107.15 | Facility | 51 · Multiple procedures | $36.31 | $56.23 | $107.15 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $77.62 Median $104.71 Typical High $218.78 | Professional | 51 · Multiple procedures | $77.62 | $104.71 | $218.78 |
Where North Carolina sits
The same service costs 3.6 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· 13th of 51
$209
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.