How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $0.32 Median $0.32 Typical High $0.32 | Facility | None | $0.32 | $0.32 | $0.32 |
Aetna Setting Professional Modifier None Typical Low $0.26 Median $0.32 Typical High $0.32 | Professional | None | $0.26 | $0.32 | $0.32 |
Ambetter Setting Professional Modifier None Typical Low $19.95 Median $19.95 Typical High $19.95 | Professional | None | $19.95 | $19.95 | $19.95 |
BCBS North Carolina Setting Professional Modifier None Typical Low $0.31 Median $0.40 Typical High $0.43 | Professional | None | $0.31 | $0.40 | $0.43 |
Cigna Setting Professional Modifier None Typical Low $0.26 Median $0.26 Typical High $0.26 | Professional | None | $0.26 | $0.26 | $0.26 |
Medcost Setting Facility Modifier None Typical Low $0.32 Median $0.51 Typical High $0.65 | Facility | None | $0.32 | $0.51 | $0.65 |
Medcost Setting Professional Modifier None Typical Low $0.33 Median $0.43 Typical High $1.00 | Professional | None | $0.33 | $0.43 | $1.00 |
United Setting Professional Modifier None Typical Low $0.19 Median $0.27 Typical High $0.31 | Professional | None | $0.19 | $0.27 | $0.31 |
5 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 55 · Aftercare only Typical Low $0.04 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.04 | $0.05 | $0.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | 56 · Pre-op care only | $0.03 | $0.03 | $0.03 |
Aetna Setting Professional Modifier AW · With surgical dressing Typical Low $0.15 Median $0.15 Typical High $0.15 | Professional | AW · With surgical dressing | $0.15 | $0.15 | $0.15 |
Medcost Setting Professional Modifier AV · With prosthetic/orthotic Typical Low $0.36 Median $0.36 Typical High $0.36 | Professional | AV · With prosthetic/orthotic | $0.36 | $0.36 | $0.36 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $0.16 Median $0.31 Typical High $0.50 | Professional | 51 · Multiple procedures | $0.16 | $0.31 | $0.50 |
Where North Carolina sits
The same service costs 2.5 times more in Montana than in Colorado. 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· 6th of 51
$0.40
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.