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 $13.49 Median $13.49 Typical High $7,943.28 | Facility | None | $13.49 | $13.49 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $12.02 Median $13.49 Typical High $16.98 | Professional | None | $12.02 | $13.49 | $16.98 |
BCBS North Carolina Setting Professional Modifier None Typical Low $21.38 Median $26.92 Typical High $38.90 | Professional | None | $21.38 | $26.92 | $38.90 |
Cigna Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $10.72 | Professional | None | $10.72 | $10.72 | $10.72 |
Medcost Setting Professional Modifier None Typical Low $19.95 Median $19.95 Typical High $19.95 | Professional | None | $19.95 | $19.95 | $19.95 |
Medcost Setting Facility Modifier None Typical Low $12.88 Median $12.88 Typical High $13.49 | Facility | None | $12.88 | $12.88 | $13.49 |
Medcost Setting Professional Modifier None Typical Low $12.88 Median $14.13 Typical High $28.18 | Professional | None | $12.88 | $14.13 | $28.18 |
United Setting Professional Modifier None Typical Low $12.30 Median $16.60 Typical High $28.84 | Professional | None | $12.30 | $16.60 | $28.84 |
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 $6.61 Median $6.76 Typical High $7.59 | Professional | 52 · Reduced service | $6.61 | $6.76 | $7.59 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.63 Median $2.69 Typical High $3.02 | Professional | 53 · Discontinued | $2.63 | $2.69 | $3.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.00 Median $10.23 Typical High $11.22 | Professional | 54 · Surgery only | $10.00 | $10.23 | $11.22 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.00 Median $2.04 Typical High $2.24 | Professional | 55 · Aftercare only | $2.00 | $2.04 | $2.24 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.32 Median $1.35 Typical High $1.51 | Professional | 56 · Pre-op care only | $1.32 | $1.35 | $1.51 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $6.46 Median $7.08 Typical High $19.50 | Professional | 51 · Multiple procedures | $6.46 | $7.08 | $19.50 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $2.57 Median $2.82 Typical High $7.76 | Professional | 80 · Assistant surgeon | $2.57 | $2.82 | $7.76 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $1.82 Median $1.95 Typical High $5.50 | Professional | 81 · Minimal assistant surgeon | $1.82 | $1.95 | $5.50 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $1.82 Median $1.95 Typical High $5.50 | Professional | 82 · Assistant surgeon, no resident | $1.82 | $1.95 | $5.50 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $1.82 Median $1.95 Typical High $5.50 | Professional | AS · PA/NP assist | $1.82 | $1.95 | $5.50 |
Where North Carolina sits
The same service costs 3.3 times more in Alaska than in Delaware. 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· 3rd of 51
$24.55
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.