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 $151.36 Typical High $7,413.10 | Facility | None | $120.23 | $151.36 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $151.36 Typical High $245.47 | Professional | None | $120.23 | $151.36 | $245.47 |
Ambetter Setting Professional Modifier None Typical Low $123.03 Median $190.55 Typical High $245.47 | Professional | None | $123.03 | $190.55 | $245.47 |
BCBS North Carolina Setting Facility Modifier None Typical Low $58.88 Median $87.10 Typical High $117.49 | Facility | None | $58.88 | $87.10 | $117.49 |
BCBS North Carolina Setting Professional Modifier None Typical Low $181.97 Median $257.04 Typical High $407.38 | Professional | None | $181.97 | $257.04 | $407.38 |
Cigna Setting Facility Modifier None Typical Low $83.18 Median $134.90 Typical High $524.81 | Facility | None | $83.18 | $134.90 | $524.81 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $177.83 Typical High $363.08 | Professional | None | $158.49 | $177.83 | $363.08 |
Medcost Setting Professional Modifier None Typical Low $363.08 Median $363.08 Typical High $363.08 | Professional | None | $363.08 | $363.08 | $363.08 |
Medcost Setting Facility Modifier None Typical Low $70.79 Median $102.33 Typical High $173.78 | Facility | None | $70.79 | $102.33 | $173.78 |
Medcost Setting Professional Modifier None Typical Low $173.78 Median $186.21 Typical High $245.47 | Professional | None | $173.78 | $186.21 | $245.47 |
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 $114.82 Median $169.82 Typical High $323.59 | Professional | None | $114.82 | $169.82 | $323.59 |
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 $60.26 Median $74.13 Typical High $79.43 | Professional | 52 · Reduced service | $60.26 | $74.13 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $30.20 Typical High $31.62 | Professional | 53 · Discontinued | $23.99 | $30.20 | $31.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $112.20 Typical High $120.23 | Professional | 54 · Surgery only | $89.13 | $112.20 | $120.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.78 Median $22.39 Typical High $23.44 | Professional | 55 · Aftercare only | $17.78 | $22.39 | $23.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $15.14 Typical High $15.85 | Professional | 56 · Pre-op care only | $12.02 | $15.14 | $15.85 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $83.18 Median $104.71 Typical High $109.65 | Professional | 78 · Unplanned return to OR | $83.18 | $104.71 | $109.65 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $33.11 Median $51.29 Typical High $87.10 | Facility | 51 · Multiple procedures | $33.11 | $51.29 | $87.10 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $93.33 Median $93.33 Typical High $177.83 | Professional | 51 · Multiple procedures | $93.33 | $93.33 | $177.83 |
Where North Carolina sits
The same service costs 3.9 times more in Alaska than in Florida. 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· 8th of 51
$251
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.