How much rates vary
Facilitymedian $89 · 10th to 90th $46 to $138Professionalmedian $120 · 10th to 90th $74 to $138
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 $138.04 Median $138.04 Typical High $138.04 | Facility | None | $138.04 | $138.04 | $138.04 |
Aetna Setting Professional Modifier None (both parts) Typical Low $75.86 Median $138.04 Typical High $138.04 | Professional | None (both parts) | $75.86 | $138.04 | $138.04 |
Ambetter Setting Professional Modifier None (both parts) Typical Low $144.54 Median $144.54 Typical High $144.54 | Professional | None (both parts) | $144.54 | $144.54 | $144.54 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $117.49 Median $120.23 Typical High $162.18 | Professional | None (both parts) | $117.49 | $120.23 | $162.18 |
Cigna Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $89.13 | Facility | None | $89.13 | $89.13 | $89.13 |
Cigna Setting Professional Modifier None (both parts) Typical Low $64.57 Median $89.13 Typical High $89.13 | Professional | None (both parts) | $64.57 | $89.13 | $89.13 |
Medcost Setting Professional Modifier None Typical Low $74.13 Median $79.43 Typical High $102.33 | Professional | None | $74.13 | $79.43 | $102.33 |
Medcost Setting Facility Modifier None Typical Low $45.71 Median $87.10 Typical High $151.36 | Facility | None | $45.71 | $87.10 | $151.36 |
Medcost Setting Professional Modifier None (both parts) Typical Low $89.13 Median $112.20 Typical High $190.55 | Professional | None (both parts) | $89.13 | $112.20 | $190.55 |
United Setting Facility Modifier None Typical Low $77.62 Median $77.62 Typical High $77.62 | Facility | None | $77.62 | $77.62 | $77.62 |
United Setting Professional Modifier None (both parts) Typical Low $53.70 Median $77.62 Typical High $104.71 | Professional | None (both parts) | $53.70 | $77.62 | $104.71 |
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 $38.90 Median $69.18 Typical High $69.18 | Professional | 52 · Reduced service | $38.90 | $69.18 | $69.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.85 Median $27.54 Typical High $27.54 | Professional | 53 · Discontinued | $15.85 | $27.54 | $27.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.75 Median $20.89 Typical High $20.89 | Professional | 55 · Aftercare only | $11.75 | $20.89 | $20.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $13.80 Typical High $13.80 | Professional | 56 · Pre-op care only | $7.76 | $13.80 | $13.80 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $44.67 Median $47.86 Typical High $107.15 | Professional | 26 · Professional part | $44.67 | $47.86 | $107.15 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $134.90 Median $169.82 Typical High $537.03 | Professional | 50 · Both sides | $134.90 | $169.82 | $537.03 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $44.67 Median $56.23 Typical High $177.83 | Professional | 51 · Multiple procedures | $44.67 | $56.23 | $177.83 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $17.78 Median $22.39 Typical High $70.79 | Professional | 80 · Assistant surgeon | $17.78 | $22.39 | $70.79 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $12.59 Median $15.85 Typical High $50.12 | Professional | 81 · Minimal assistant surgeon | $12.59 | $15.85 | $50.12 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $12.59 Median $15.85 Typical High $50.12 | Professional | 82 · Assistant surgeon, no resident | $12.59 | $15.85 | $50.12 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $12.59 Median $15.85 Typical High $50.12 | Professional | AS · PA/NP assist | $12.59 | $15.85 | $50.12 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $44.67 Median $44.67 Typical High $44.67 | Professional | SH · Second concurrent infusion | $44.67 | $44.67 | $44.67 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $44.67 Median $44.67 Typical High $44.67 | Professional | SJ · Third+ concurrent infusion | $44.67 | $44.67 | $44.67 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $67.61 Median $70.79 Typical High $158.49 | Professional | TC · Technical part | $67.61 | $70.79 | $158.49 |
Where North Carolina sits
The same service costs 2.8 times more in Kansas 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· 17th of 51
$120
KS $178DE $64.57
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.