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 $36.31 Median $36.31 Typical High $41.69 | Facility | None | $36.31 | $36.31 | $41.69 |
Aetna Setting Professional Modifier None Typical Low $35.48 Median $37.15 Typical High $41.69 | Professional | None | $35.48 | $37.15 | $41.69 |
Ambetter Setting Professional Modifier None Typical Low $25.12 Median $25.12 Typical High $25.12 | Professional | None | $25.12 | $25.12 | $25.12 |
BCBS North Carolina Setting Professional Modifier None Typical Low $21.38 Median $32.36 Typical High $74.13 | Professional | None | $21.38 | $32.36 | $74.13 |
Cigna Setting Professional Modifier None Typical Low $29.51 Median $29.51 Typical High $29.51 | Professional | None | $29.51 | $29.51 | $29.51 |
Medcost Setting Professional Modifier None Typical Low $25.12 Median $30.90 Typical High $30.90 | Professional | None | $25.12 | $30.90 | $30.90 |
Medcost Setting Facility Modifier None Typical Low $30.20 Median $36.31 Typical High $46.77 | Facility | None | $30.20 | $36.31 | $46.77 |
Medcost Setting Professional Modifier None Typical Low $18.20 Median $21.38 Typical High $23.99 | Professional | None | $18.20 | $21.38 | $23.99 |
Oscar Health Setting Professional Modifier None Typical Low $22.91 Median $43.65 Typical High $69.18 | Professional | None | $22.91 | $43.65 | $69.18 |
United Setting Professional Modifier None Typical Low $22.91 Median $28.84 Typical High $51.29 | Professional | None | $22.91 | $28.84 | $51.29 |
9 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 $18.20 Median $18.62 Typical High $20.89 | Professional | 52 · Reduced service | $18.20 | $18.62 | $20.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.24 Median $7.41 Typical High $8.32 | Professional | 53 · Discontinued | $7.24 | $7.41 | $8.32 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.37 Median $5.62 Typical High $6.31 | Professional | 55 · Aftercare only | $5.37 | $5.62 | $6.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.63 Median $3.72 Typical High $4.17 | Professional | 56 · Pre-op care only | $3.63 | $3.72 | $4.17 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $8.91 Median $10.72 Typical High $12.02 | Professional | 51 · Multiple procedures | $8.91 | $10.72 | $12.02 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $3.63 Median $4.37 Typical High $4.90 | Professional | 80 · Assistant surgeon | $3.63 | $4.37 | $4.90 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $2.51 Median $3.02 Typical High $3.39 | Professional | 81 · Minimal assistant surgeon | $2.51 | $3.02 | $3.39 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $2.51 Median $3.02 Typical High $3.39 | Professional | 82 · Assistant surgeon, no resident | $2.51 | $3.02 | $3.39 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $2.51 Median $3.02 Typical High $3.39 | Professional | AS · PA/NP assist | $2.51 | $3.02 | $3.39 |
Where North Carolina sits
The same service costs 3.8 times more in Alaska than in Indiana. 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· 30th of 51
$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.