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 $123.03 Typical High $144.54 | Facility | None | $109.65 | $123.03 | $144.54 |
Aetna Setting Professional Modifier None Typical Low $97.72 Median $123.03 Typical High $154.88 | Professional | None | $97.72 | $123.03 | $154.88 |
Ambetter Setting Professional Modifier None Typical Low $107.15 Median $107.15 Typical High $107.15 | Professional | None | $107.15 | $107.15 | $107.15 |
BCBS North Carolina Setting Professional Modifier None Typical Low $109.65 Median $109.65 Typical High $147.91 | Professional | None | $109.65 | $109.65 | $147.91 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $162.18 Typical High $269.15 | Professional | None | $97.72 | $162.18 | $269.15 |
Medcost Setting Facility Modifier None Typical Low $81.28 Median $144.54 Typical High $158.49 | Facility | None | $81.28 | $144.54 | $158.49 |
Medcost Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $128.82 | Professional | None | $128.82 | $128.82 | $128.82 |
Oscar Health Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $138.04 | Professional | None | $138.04 | $138.04 | $138.04 |
United Setting Professional Modifier None Typical Low $97.72 Median $125.89 Typical High $251.19 | Professional | None | $97.72 | $125.89 | $251.19 |
10 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 $53.70 Median $61.66 Typical High $63.10 | Professional | 52 · Reduced service | $53.70 | $61.66 | $63.10 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $18.62 Typical High $19.05 | Professional | 55 · Aftercare only | $16.22 | $18.62 | $19.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.72 Median $12.30 Typical High $12.59 | Professional | 56 · Pre-op care only | $10.72 | $12.30 | $12.59 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $64.57 Median $64.57 Typical High $64.57 | Professional | 51 · Multiple procedures | $64.57 | $64.57 | $64.57 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | 80 · Assistant surgeon | $25.70 | $25.70 | $25.70 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $18.20 Median $18.20 Typical High $18.20 | Professional | 81 · Minimal assistant surgeon | $18.20 | $18.20 | $18.20 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $18.20 Median $18.20 Typical High $18.20 | Professional | 82 · Assistant surgeon, no resident | $18.20 | $18.20 | $18.20 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $18.20 Median $18.20 Typical High $18.20 | Professional | AS · PA/NP assist | $18.20 | $18.20 | $18.20 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $64.57 Median $64.57 Typical High $64.57 | Professional | SH · Second concurrent infusion | $64.57 | $64.57 | $64.57 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $64.57 Median $64.57 Typical High $64.57 | Professional | SJ · Third+ concurrent infusion | $64.57 | $64.57 | $64.57 |
Where North Carolina sits
The same service costs 2.1 times more in Wisconsin than in Ohio. 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· 26th of 51
$129
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.