How much rates vary
Facilitymedian $65 · 10th to 90th $28 to $98Professionalmedian $85 · 10th to 90th $50 to $98
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 $97.72 Median $97.72 Typical High $97.72 | Facility | None | $97.72 | $97.72 | $97.72 |
Aetna Setting Professional Modifier None (both parts) Typical Low $52.48 Median $97.72 Typical High $97.72 | Professional | None (both parts) | $52.48 | $97.72 | $97.72 |
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 $114.82 | Professional | None (both parts) | $64.57 | $85.11 | $114.82 |
Cigna Setting Facility Modifier None Typical Low $64.57 Median $64.57 Typical High $64.57 | Facility | None | $64.57 | $64.57 | $64.57 |
Cigna Setting Professional Modifier None (both parts) Typical Low $46.77 Median $64.57 Typical High $67.61 | Professional | None (both parts) | $46.77 | $64.57 | $67.61 |
Medcost Setting Professional Modifier None Typical Low $41.69 Median $44.67 Typical High $67.61 | Professional | None | $41.69 | $44.67 | $67.61 |
Medcost Setting Facility Modifier None Typical Low $28.18 Median $60.26 Typical High $97.72 | Facility | None | $28.18 | $60.26 | $97.72 |
Medcost Setting Professional Modifier None (both parts) Typical Low $63.10 Median $79.43 Typical High $134.90 | Professional | None (both parts) | $63.10 | $79.43 | $134.90 |
United Setting Facility Modifier None Typical Low $57.54 Median $57.54 Typical High $60.26 | Facility | None | $57.54 | $57.54 | $60.26 |
United Setting Professional Modifier None (both parts) Typical Low $37.15 Median $52.48 Typical High $66.07 | Professional | None (both parts) | $37.15 | $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 $26.30 Median $48.98 Typical High $48.98 | Professional | 52 · Reduced service | $26.30 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $19.50 Typical High $19.50 | Professional | 53 · Discontinued | $10.47 | $19.50 | $19.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $14.79 Typical High $14.79 | Professional | 55 · Aftercare only | $7.94 | $14.79 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $9.77 Typical High $9.77 | Professional | 56 · Pre-op care only | $5.25 | $9.77 | $9.77 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $31.62 Median $33.11 Typical High $74.13 | Professional | 26 · Professional part | $31.62 | $33.11 | $74.13 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $95.50 Median $117.49 Typical High $380.19 | Professional | 50 · Both sides | $95.50 | $117.49 | $380.19 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $31.62 Median $39.81 Typical High $125.89 | Professional | 51 · Multiple procedures | $31.62 | $39.81 | $125.89 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $12.59 Median $15.85 Typical High $50.12 | Professional | 80 · Assistant surgeon | $12.59 | $15.85 | $50.12 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $8.91 Median $10.96 Typical High $35.48 | Professional | 81 · Minimal assistant surgeon | $8.91 | $10.96 | $35.48 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $8.91 Median $10.96 Typical High $35.48 | Professional | 82 · Assistant surgeon, no resident | $8.91 | $10.96 | $35.48 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $8.91 Median $10.96 Typical High $35.48 | Professional | AS · PA/NP assist | $8.91 | $10.96 | $35.48 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $31.62 Median $31.62 Typical High $31.62 | Professional | SH · Second concurrent infusion | $31.62 | $31.62 | $31.62 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $31.62 Median $31.62 Typical High $31.62 | Professional | SJ · Third+ concurrent infusion | $31.62 | $31.62 | $31.62 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $47.86 Median $50.12 Typical High $112.20 | Professional | TC · Technical part | $47.86 | $50.12 | $112.20 |
Where North Carolina sits
The same service costs 3.5 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· 9th of 51
$85.11
HI $166NJ $46.77
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.