How much rates vary
Facilitymedian $22 · 10th to 90th $10 to $30Professionalmedian $26 · 10th to 90th $16 to $30
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 $17.38 Median $29.51 Typical High $29.51 | Facility | None | $17.38 | $29.51 | $29.51 |
Aetna Setting Professional Modifier None (both parts) Typical Low $16.22 Median $29.51 Typical High $29.51 | Professional | None (both parts) | $16.22 | $29.51 | $29.51 |
Ambetter Setting Professional Modifier None (both parts) Typical Low $34.67 Median $34.67 Typical High $34.67 | Professional | None (both parts) | $34.67 | $34.67 | $34.67 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $22.39 Median $25.70 Typical High $27.54 | Professional | None (both parts) | $22.39 | $25.70 | $27.54 |
Cigna Setting Facility Modifier None Typical Low $22.39 Median $22.39 Typical High $24.55 | Facility | None | $22.39 | $22.39 | $24.55 |
Cigna Setting Professional Modifier None (both parts) Typical Low $16.22 Median $22.39 Typical High $22.91 | Professional | None (both parts) | $16.22 | $22.39 | $22.91 |
Medcost Setting Professional Modifier None Typical Low $13.80 Median $15.14 Typical High $20.89 | Professional | None | $13.80 | $15.14 | $20.89 |
Medcost Setting Facility Modifier None Typical Low $9.55 Median $18.62 Typical High $30.20 | Facility | None | $9.55 | $18.62 | $30.20 |
Medcost Setting Professional Modifier None (both parts) Typical Low $19.05 Median $23.99 Typical High $47.86 | Professional | None (both parts) | $19.05 | $23.99 | $47.86 |
United Setting Facility Modifier None Typical Low $19.95 Median $19.95 Typical High $28.18 | Facility | None | $19.95 | $19.95 | $28.18 |
United Setting Professional Modifier None (both parts) Typical Low $11.48 Median $16.22 Typical High $21.88 | Professional | None (both parts) | $11.48 | $16.22 | $21.88 |
14 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 $8.32 Median $14.79 Typical High $14.79 | Professional | 52 · Reduced service | $8.32 | $14.79 | $14.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.39 Median $5.89 Typical High $5.89 | Professional | 53 · Discontinued | $3.39 | $5.89 | $5.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.51 Median $4.47 Typical High $4.47 | Professional | 55 · Aftercare only | $2.51 | $4.47 | $4.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.70 Median $2.95 Typical High $2.95 | Professional | 56 · Pre-op care only | $1.70 | $2.95 | $2.95 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $9.55 Median $10.23 Typical High $23.99 | Professional | 26 · Professional part | $9.55 | $10.23 | $23.99 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $28.18 Median $36.31 Typical High $114.82 | Professional | 50 · Both sides | $28.18 | $36.31 | $114.82 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $9.55 Median $12.02 Typical High $38.02 | Professional | 51 · Multiple procedures | $9.55 | $12.02 | $38.02 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $3.80 Median $4.79 Typical High $15.14 | Professional | 80 · Assistant surgeon | $3.80 | $4.79 | $15.14 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $2.63 Median $3.39 Typical High $10.72 | Professional | 81 · Minimal assistant surgeon | $2.63 | $3.39 | $10.72 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $2.63 Median $3.39 Typical High $10.72 | Professional | 82 · Assistant surgeon, no resident | $2.63 | $3.39 | $10.72 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $2.63 Median $3.39 Typical High $10.72 | Professional | AS · PA/NP assist | $2.63 | $3.39 | $10.72 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | SH · Second concurrent infusion | $9.55 | $9.55 | $9.55 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | SJ · Third+ concurrent infusion | $9.55 | $9.55 | $9.55 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $14.45 Median $15.14 Typical High $36.31 | Professional | TC · Technical part | $14.45 | $15.14 | $36.31 |
Where North Carolina sits
The same service costs 3.7 times more in Hawaii than in Florida. 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· 17th of 51
$25.70
HI $60.26FL $16.22
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.