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 $165.96 Typical High $7,585.78 | Facility | None | $109.65 | $165.96 | $7,585.78 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $151.36 Typical High $181.97 | Professional | None | $109.65 | $151.36 | $181.97 |
BCBS North Carolina Setting Facility Modifier None Typical Low $56.23 Median $87.10 Typical High $223.87 | Facility | None | $56.23 | $87.10 | $223.87 |
BCBS North Carolina Setting Professional Modifier None Typical Low $158.49 Median $288.40 Typical High $389.05 | Professional | None | $158.49 | $288.40 | $389.05 |
Cigna Setting Facility Modifier None Typical Low $107.15 Median $169.82 Typical High $645.65 | Facility | None | $107.15 | $169.82 | $645.65 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $165.96 Typical High $346.74 | Professional | None | $138.04 | $165.96 | $346.74 |
Medcost Setting Facility Modifier None Typical Low $69.18 Median $100.00 Typical High $218.78 | Facility | None | $69.18 | $100.00 | $218.78 |
Medcost Setting Professional Modifier None Typical Low $158.49 Median $177.83 Typical High $281.84 | Professional | None | $158.49 | $177.83 | $281.84 |
United Setting Facility Modifier None Typical Low $851.14 Median $1,698.24 Typical High $8,709.64 | Facility | None | $851.14 | $1,698.24 | $8,709.64 |
United Setting Professional Modifier None Typical Low $112.20 Median $173.78 Typical High $354.81 | Professional | None | $112.20 | $173.78 | $354.81 |
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 $66.07 Typical High $83.18 | Professional | 52 · Reduced service | $54.95 | $66.07 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $26.30 Typical High $33.11 | Professional | 53 · Discontinued | $21.88 | $26.30 | $33.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $100.00 Typical High $125.89 | Professional | 54 · Surgery only | $83.18 | $100.00 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $19.95 Typical High $25.12 | Professional | 55 · Aftercare only | $16.60 | $19.95 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $13.18 Typical High $16.60 | Professional | 56 · Pre-op care only | $10.96 | $13.18 | $16.60 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $77.62 Median $93.33 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $77.62 | $93.33 | $117.49 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $32.36 Median $50.12 Typical High $85.11 | Facility | 51 · Multiple procedures | $32.36 | $50.12 | $85.11 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $79.43 Median $123.03 Typical High $213.80 | Professional | 51 · Multiple procedures | $79.43 | $123.03 | $213.80 |
Where North Carolina sits
The same service costs 3.6 times more in Wisconsin than in Texas. 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· 10th of 51
$234
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.