How much rates vary
Facilitymedian $63 · 10th to 90th $28 to $95Professionalmedian $85 · 10th to 90th $50 to $95
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 $95.50 Median $95.50 Typical High $95.50 | Facility | None | $95.50 | $95.50 | $95.50 |
Aetna Setting Professional Modifier None (both parts) Typical Low $52.48 Median $95.50 Typical High $95.50 | Professional | None (both parts) | $52.48 | $95.50 | $95.50 |
Ambetter Setting Professional Modifier None (both parts) Typical Low $85.11 Median $85.11 Typical High $85.11 | Professional | None (both parts) | $85.11 | $85.11 | $85.11 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $64.57 Median $85.11 Typical High $112.20 | Professional | None (both parts) | $64.57 | $85.11 | $112.20 |
Cigna Setting Facility Modifier None Typical Low $63.10 Median $63.10 Typical High $63.10 | Facility | None | $63.10 | $63.10 | $63.10 |
Cigna Setting Professional Modifier None (both parts) Typical Low $45.71 Median $63.10 Typical High $67.61 | Professional | None (both parts) | $45.71 | $63.10 | $67.61 |
Medcost Setting Professional Modifier None Typical Low $43.65 Median $47.86 Typical High $64.57 | Professional | None | $43.65 | $47.86 | $64.57 |
Medcost Setting Facility Modifier None Typical Low $28.18 Median $60.26 Typical High $95.50 | Facility | None | $28.18 | $60.26 | $95.50 |
Medcost Setting Professional Modifier None (both parts) Typical Low $61.66 Median $77.62 Typical High $131.83 | Professional | None (both parts) | $61.66 | $77.62 | $131.83 |
United Setting Facility Modifier None Typical Low $56.23 Median $56.23 Typical High $58.88 | Facility | None | $56.23 | $56.23 | $58.88 |
United Setting Professional Modifier None (both parts) Typical Low $36.31 Median $52.48 Typical High $66.07 | Professional | None (both parts) | $36.31 | $52.48 | $66.07 |
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 $26.92 Median $47.86 Typical High $47.86 | Professional | 52 · Reduced service | $26.92 | $47.86 | $47.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.72 Median $19.50 Typical High $19.50 | Professional | 53 · Discontinued | $10.72 | $19.50 | $19.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $14.45 Typical High $14.45 | Professional | 55 · Aftercare only | $7.94 | $14.45 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.37 Median $9.55 Typical High $9.55 | Professional | 56 · Pre-op care only | $5.37 | $9.55 | $9.55 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $30.90 Median $33.11 Typical High $74.13 | Professional | 26 · Professional part | $30.90 | $33.11 | $74.13 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $93.33 Median $117.49 Typical High $371.54 | Professional | 50 · Both sides | $93.33 | $117.49 | $371.54 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $30.90 Median $38.90 Typical High $123.03 | Professional | 51 · Multiple procedures | $30.90 | $38.90 | $123.03 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $12.30 Median $15.49 Typical High $50.12 | Professional | 80 · Assistant surgeon | $12.30 | $15.49 | $50.12 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $8.71 Median $10.96 Typical High $34.67 | Professional | 81 · Minimal assistant surgeon | $8.71 | $10.96 | $34.67 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $8.71 Median $10.96 Typical High $34.67 | Professional | 82 · Assistant surgeon, no resident | $8.71 | $10.96 | $34.67 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $8.71 Median $10.96 Typical High $34.67 | Professional | AS · PA/NP assist | $8.71 | $10.96 | $34.67 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $30.90 Median $30.90 Typical High $30.90 | Professional | SH · Second concurrent infusion | $30.90 | $30.90 | $30.90 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $30.90 Median $30.90 Typical High $30.90 | Professional | SJ · Third+ concurrent infusion | $30.90 | $30.90 | $30.90 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $46.77 Median $50.12 Typical High $112.20 | Professional | TC · Technical part | $46.77 | $50.12 | $112.20 |
Where North Carolina sits
The same service costs 3.2 times more in Hawaii than in New Jersey. 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· 10th of 51
$85.11
HI $148NJ $45.71
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.