How much rates vary
Facilitymedian $50 · 10th to 90th $35 to $79Professionalmedian $52 · 10th to 90th $33 to $95
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 $35.48 Median $48.98 Typical High $63.10 | Facility | None | $35.48 | $48.98 | $63.10 |
Aetna Setting Professional Modifier None Typical Low $33.11 Median $46.77 Typical High $57.54 | Professional | None | $33.11 | $46.77 | $57.54 |
Ambetter Setting Professional Modifier None Typical Low $30.20 Median $47.86 Typical High $79.43 | Professional | None | $30.20 | $47.86 | $79.43 |
BCBS North Carolina Setting Professional Modifier None Typical Low $38.02 Median $58.88 Typical High $102.33 | Professional | None | $38.02 | $58.88 | $102.33 |
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 $25.70 Median $39.81 Typical High $64.57 | Professional | None | $25.70 | $39.81 | $64.57 |
Medcost Setting Professional Modifier None Typical Low $36.31 Median $45.71 Typical High $52.48 | Professional | None | $36.31 | $45.71 | $52.48 |
Medcost Setting Facility Modifier None Typical Low $35.48 Median $42.66 Typical High $67.61 | Facility | None | $35.48 | $42.66 | $67.61 |
Medcost Setting Professional Modifier None Typical Low $41.69 Median $41.69 Typical High $60.26 | Professional | None | $41.69 | $41.69 | $60.26 |
Oscar Health Setting Professional Modifier None Typical Low $38.02 Median $57.54 Typical High $114.82 | Professional | None | $38.02 | $57.54 | $114.82 |
United Setting Professional Modifier None Typical Low $21.38 Median $37.15 Typical High $58.88 | Professional | None | $21.38 | $37.15 | $58.88 |
22 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 $17.78 Median $20.42 Typical High $27.54 | Facility | 52 · Reduced service | $17.78 | $20.42 | $27.54 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $5.37 Median $6.17 Typical High $8.13 | Facility | 55 · Aftercare only | $5.37 | $6.17 | $8.13 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $3.55 Median $4.07 Typical High $5.50 | Facility | 56 · Pre-op care only | $3.55 | $4.07 | $5.50 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $15.49 Median $17.78 Typical High $27.54 | Professional | 52 · Reduced service | $15.49 | $17.78 | $27.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.68 Median $5.37 Typical High $8.13 | Professional | 55 · Aftercare only | $4.68 | $5.37 | $8.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.16 Median $3.55 Typical High $5.50 | Professional | 56 · Pre-op care only | $3.16 | $3.55 | $5.50 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $47.86 Median $93.33 Typical High $93.33 | Professional | 24 · Unrelated visit after surgery | $47.86 | $93.33 | $93.33 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $47.86 Median $56.23 Typical High $66.07 | Professional | 25 · Same-day visit | $47.86 | $56.23 | $66.07 |
Ambetter Setting Professional Modifier 93 · Audio-only telehealth Typical Low $25.70 Median $28.18 Typical High $30.20 | Professional | 93 · Audio-only telehealth | $25.70 | $28.18 | $30.20 |
Ambetter Setting Professional Modifier FP · Family planning Typical Low $47.86 Median $47.86 Typical High $47.86 | Professional | FP · Family planning | $47.86 | $47.86 | $47.86 |
Ambetter Setting Professional Modifier FQ · Audio-only Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | FQ · Audio-only | $30.20 | $30.20 | $30.20 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $42.66 Median $93.33 Typical High $93.33 | Professional | GC · Resident with teaching physician | $42.66 | $93.33 | $93.33 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $79.43 Median $93.33 Typical High $93.33 | Professional | GE · Resident, primary care exception | $79.43 | $93.33 | $93.33 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $43.65 Median $43.65 Typical High $43.65 | Professional | Q6 · Substitute physician, paid per time | $43.65 | $43.65 | $43.65 |
Ambetter Setting Professional Modifier TH · Pregnancy care Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | TH · Pregnancy care | $60.26 | $60.26 | $60.26 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $20.89 Median $20.89 Typical High $30.90 | Professional | 51 · Multiple procedures | $20.89 | $20.89 | $30.90 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $8.32 Median $8.32 Typical High $12.30 | Professional | 80 · Assistant surgeon | $8.32 | $8.32 | $12.30 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $5.89 Median $5.89 Typical High $8.71 | Professional | 81 · Minimal assistant surgeon | $5.89 | $5.89 | $8.71 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $5.89 Median $5.89 Typical High $8.71 | Professional | 82 · Assistant surgeon, no resident | $5.89 | $5.89 | $8.71 |
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 $5.89 Median $5.89 Typical High $8.71 | Professional | AS · PA/NP assist | $5.89 | $5.89 | $8.71 |
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 2.4 times more in Alaska than in New Jersey. 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
$52.48
AK $77.62NJ $32.36
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.