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 $97.72 Median $123.03 Typical High $7,413.10 | Facility | None | $97.72 | $123.03 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $97.72 Median $123.03 Typical High $199.53 | Professional | None | $97.72 | $123.03 | $199.53 |
Ambetter Setting Professional Modifier None Typical Low $114.82 Median $125.89 Typical High $213.80 | Professional | None | $114.82 | $125.89 | $213.80 |
BCBS North Carolina Setting Facility Modifier None Typical Low $67.61 Median $100.00 Typical High $134.90 | Facility | None | $67.61 | $100.00 | $134.90 |
BCBS North Carolina Setting Professional Modifier None Typical Low $100.00 Median $151.36 Typical High $323.59 | Professional | None | $100.00 | $151.36 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $95.50 Median $151.36 Typical High $524.81 | Facility | None | $95.50 | $151.36 | $524.81 |
Cigna Setting Professional Modifier None Typical Low $85.11 Median $109.65 Typical High $223.87 | Professional | None | $85.11 | $109.65 | $223.87 |
Medcost Setting Facility Modifier None Typical Low $91.20 Median $131.83 Typical High $204.17 | Facility | None | $91.20 | $131.83 | $204.17 |
Medcost Setting Professional Modifier None Typical Low $123.03 Median $173.78 Typical High $194.98 | Professional | None | $123.03 | $173.78 | $194.98 |
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 $95.50 Median $123.03 Typical High $239.88 | Professional | None | $95.50 | $123.03 | $239.88 |
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 $48.98 Median $61.66 Typical High $70.79 | Professional | 52 · Reduced service | $48.98 | $61.66 | $70.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.50 Median $24.55 Typical High $28.18 | Professional | 53 · Discontinued | $19.50 | $24.55 | $28.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $93.33 Typical High $107.15 | Professional | 54 · Surgery only | $74.13 | $93.33 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $18.62 Typical High $21.38 | Professional | 55 · Aftercare only | $14.79 | $18.62 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.77 Median $12.30 Typical High $14.13 | Professional | 56 · Pre-op care only | $9.77 | $12.30 | $14.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $87.10 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $69.18 | $87.10 | $100.00 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $41.69 Median $66.07 Typical High $102.33 | Facility | 51 · Multiple procedures | $41.69 | $66.07 | $102.33 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $61.66 Median $89.13 Typical High $109.65 | Professional | 51 · Multiple procedures | $61.66 | $89.13 | $109.65 |
Where North Carolina sits
The same service costs 4.0 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· 31st of 51
$141
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.