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 $2.51 Median $2.51 Typical High $2.51 | Facility | None | $2.51 | $2.51 | $2.51 |
Aetna Setting Professional Modifier None Typical Low $0.85 Median $2.51 Typical High $2.51 | Professional | None | $0.85 | $2.51 | $2.51 |
Ambetter Setting Professional Modifier None Typical Low $1.86 Median $1.86 Typical High $2.34 | Professional | None | $1.86 | $1.86 | $2.34 |
BCBS North Carolina Setting Professional Modifier None Typical Low $2.19 Median $2.19 Typical High $2.34 | Professional | None | $2.19 | $2.19 | $2.34 |
Cigna Setting Facility Modifier None Typical Low $1.74 Median $1.74 Typical High $2.14 | Facility | None | $1.74 | $1.74 | $2.14 |
Cigna Setting Professional Modifier None Typical Low $1.48 Median $1.74 Typical High $2.04 | Professional | None | $1.48 | $1.74 | $2.04 |
Medcost Setting Professional Modifier None Typical Low $1.35 Median $1.45 Typical High $2.09 | Professional | None | $1.35 | $1.45 | $2.09 |
Medcost Setting Facility Modifier None Typical Low $0.79 Median $1.58 Typical High $2.75 | Facility | None | $0.79 | $1.58 | $2.75 |
Medcost Setting Professional Modifier None Typical Low $2.00 Median $2.19 Typical High $3.47 | Professional | None | $2.00 | $2.19 | $3.47 |
United Setting Professional Modifier None Typical Low $0.95 Median $1.38 Typical High $1.82 | Professional | None | $0.95 | $1.38 | $1.82 |
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 $0.93 Median $1.26 Typical High $1.26 | Professional | 52 · Reduced service | $0.93 | $1.26 | $1.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.37 Median $0.50 Typical High $0.50 | Professional | 53 · Discontinued | $0.37 | $0.50 | $0.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.28 Median $0.38 Typical High $0.38 | Professional | 55 · Aftercare only | $0.28 | $0.38 | $0.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.19 Median $0.25 Typical High $0.25 | Professional | 56 · Pre-op care only | $0.19 | $0.25 | $0.25 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $2.19 Median $2.19 Typical High $2.95 | Professional | KX · Policy requirements met | $2.19 | $2.19 | $2.95 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $1.00 Median $1.07 Typical High $3.24 | Professional | 51 · Multiple procedures | $1.00 | $1.07 | $3.24 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | SH · Second concurrent infusion | $1.00 | $1.00 | $1.00 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | SJ · Third+ concurrent infusion | $1.00 | $1.00 | $1.00 |
Where North Carolina sits
The same service costs 2.2 times more in Kansas 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· 20th of 51
$2.19
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.