How much rates vary
Facilitymedian $98 · 10th to 90th $81 to $132Professionalmedian $135 · 10th to 90th $81 to $224
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 $81.28 Median $95.50 Typical High $125.89 | Facility | None | $81.28 | $95.50 | $125.89 |
Aetna Setting Professional Modifier None Typical Low $69.18 Median $93.33 Typical High $117.49 | Professional | None | $69.18 | $93.33 | $117.49 |
Ambetter Setting Professional Modifier None Typical Low $64.57 Median $112.20 Typical High $154.88 | Professional | None | $64.57 | $112.20 | $154.88 |
BCBS North Carolina Setting Professional Modifier None Typical Low $100.00 Median $151.36 Typical High $234.42 | Professional | None | $100.00 | $151.36 | $234.42 |
Cigna Setting Facility Modifier None Typical Low $95.50 Median $114.82 Typical High $151.36 | Facility | None | $95.50 | $114.82 | $151.36 |
Cigna Setting Professional Modifier None Typical Low $77.62 Median $102.33 Typical High $154.88 | Professional | None | $77.62 | $102.33 | $154.88 |
Medcost Setting Professional Modifier None Typical Low $93.33 Median $114.82 Typical High $134.90 | Professional | None | $93.33 | $114.82 | $134.90 |
Medcost Setting Facility Modifier None Typical Low $81.28 Median $104.71 Typical High $131.83 | Facility | None | $81.28 | $104.71 | $131.83 |
Medcost Setting Professional Modifier None Typical Low $74.13 Median $104.71 Typical High $138.04 | Professional | None | $74.13 | $104.71 | $138.04 |
Oscar Health Setting Professional Modifier None Typical Low $83.18 Median $117.49 Typical High $229.09 | Professional | None | $83.18 | $117.49 | $229.09 |
United Setting Professional Modifier None Typical Low $63.10 Median $91.20 Typical High $144.54 | Professional | None | $63.10 | $91.20 | $144.54 |
19 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 Facility Modifier 52 · Reduced service Typical Low $40.74 Median $46.77 Typical High $54.95 | Facility | 52 · Reduced service | $40.74 | $46.77 | $54.95 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $12.30 Median $14.13 Typical High $16.22 | Facility | 55 · Aftercare only | $12.30 | $14.13 | $16.22 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $8.13 Median $9.33 Typical High $10.96 | Facility | 56 · Pre-op care only | $8.13 | $9.33 | $10.96 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $38.90 Median $40.74 Typical High $54.95 | Professional | 52 · Reduced service | $38.90 | $40.74 | $54.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.75 Median $12.30 Typical High $16.22 | Professional | 55 · Aftercare only | $11.75 | $12.30 | $16.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $8.13 Typical High $10.96 | Professional | 56 · Pre-op care only | $7.76 | $8.13 | $10.96 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $85.11 Median $112.20 Typical High $162.18 | Professional | 25 · Same-day visit | $85.11 | $112.20 | $162.18 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $123.03 Median $186.21 Typical High $186.21 | Professional | 57 · Decision for surgery | $123.03 | $186.21 | $186.21 |
Ambetter Setting Professional Modifier 93 · Audio-only telehealth Typical Low $69.18 Median $69.18 Typical High $69.18 | Professional | 93 · Audio-only telehealth | $69.18 | $69.18 | $69.18 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $112.20 Median $154.88 Typical High $186.21 | Professional | GC · Resident with teaching physician | $112.20 | $154.88 | $186.21 |
Ambetter Setting Professional Modifier HI · Mental health + developmental disability Typical Low $52.48 Median $52.48 Typical High $52.48 | Professional | HI · Mental health + developmental disability | $52.48 | $52.48 | $52.48 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | Q6 · Substitute physician, paid per time | $177.83 | $177.83 | $177.83 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $43.65 Median $52.48 Typical High $72.44 | Professional | 51 · Multiple procedures | $43.65 | $52.48 | $72.44 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $17.38 Median $20.89 Typical High $28.84 | Professional | 80 · Assistant surgeon | $17.38 | $20.89 | $28.84 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $12.02 Median $14.79 Typical High $19.95 | Professional | 81 · Minimal assistant surgeon | $12.02 | $14.79 | $19.95 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $12.02 Median $14.79 Typical High $19.95 | Professional | 82 · Assistant surgeon, no resident | $12.02 | $14.79 | $19.95 |
Medcost Setting Professional Modifier 93 · Audio-only telehealth Typical Low $50.12 Median $50.12 Typical High $50.12 | Professional | 93 · Audio-only telehealth | $50.12 | $50.12 | $50.12 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $12.02 Median $14.79 Typical High $19.95 | Professional | AS · PA/NP assist | $12.02 | $14.79 | $19.95 |
Medcost Setting Professional Modifier FQ · Audio-only Typical Low $50.12 Median $50.12 Typical High $50.12 | Professional | FQ · Audio-only | $50.12 | $50.12 | $50.12 |
Where North Carolina sits
The same service costs 2.3 times more in Alaska than in Alabama. 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
$135
AK $170AL $74.13
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.