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 $120.23 Median $173.78 Typical High $7,413.10 | Facility | None | $120.23 | $173.78 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $173.78 Typical High $269.15 | Professional | None | $120.23 | $173.78 | $269.15 |
Ambetter Setting Professional Modifier None Typical Low $131.83 Median $169.82 Typical High $229.09 | Professional | None | $131.83 | $169.82 | $229.09 |
BCBS North Carolina Setting Facility Modifier None Typical Low $69.18 Median $107.15 Typical High $275.42 | Facility | None | $69.18 | $107.15 | $275.42 |
BCBS North Carolina Setting Professional Modifier None Typical Low $177.83 Median $263.03 Typical High $407.38 | Professional | None | $177.83 | $263.03 | $407.38 |
Cigna Setting Facility Modifier None Typical Low $114.82 Median $177.83 Typical High $524.81 | Facility | None | $114.82 | $177.83 | $524.81 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $186.21 Typical High $371.54 | Professional | None | $147.91 | $186.21 | $371.54 |
Medcost Setting Facility Modifier None Typical Low $85.11 Median $123.03 Typical High $208.93 | Facility | None | $85.11 | $123.03 | $208.93 |
Medcost Setting Professional Modifier None Typical Low $169.82 Median $223.87 Typical High $288.40 | Professional | None | $169.82 | $223.87 | $288.40 |
United Setting Facility Modifier None Typical Low $295.12 Median $524.81 Typical High $2,818.38 | Facility | None | $295.12 | $524.81 | $2,818.38 |
United Setting Professional Modifier None Typical Low $123.03 Median $190.55 Typical High $380.19 | Professional | None | $123.03 | $190.55 | $380.19 |
7 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 $60.26 Median $75.86 Typical High $87.10 | Professional | 52 · Reduced service | $60.26 | $75.86 | $87.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $30.20 Typical High $34.67 | Professional | 53 · Discontinued | $23.99 | $30.20 | $34.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $114.82 Typical High $131.83 | Professional | 54 · Surgery only | $89.13 | $114.82 | $131.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.78 Median $22.91 Typical High $26.30 | Professional | 55 · Aftercare only | $17.78 | $22.91 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $15.14 Typical High $17.38 | Professional | 56 · Pre-op care only | $12.02 | $15.14 | $17.38 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $38.90 Median $61.66 Typical High $100.00 | Facility | 51 · Multiple procedures | $38.90 | $61.66 | $100.00 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $97.72 Median $123.03 Typical High $239.88 | Professional | 51 · Multiple procedures | $97.72 | $123.03 | $239.88 |
Where North Carolina sits
The same service costs 3.7 times more in Wisconsin 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
$245
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.