How much rates vary
Facilitymedian $71 · 10th to 90th $28 to $87Professionalmedian $76 · 10th to 90th $47 to $87
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 $87.10 Median $87.10 Typical High $87.10 | Facility | None | $87.10 | $87.10 | $87.10 |
Aetna Setting Professional Modifier None (both parts) Typical Low $47.86 Median $87.10 Typical High $87.10 | Professional | None (both parts) | $47.86 | $87.10 | $87.10 |
Ambetter Setting Professional Modifier None (both parts) Typical Low $91.20 Median $91.20 Typical High $91.20 | Professional | None (both parts) | $91.20 | $91.20 | $91.20 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $64.57 Median $75.86 Typical High $81.28 | Professional | None (both parts) | $64.57 | $75.86 | $81.28 |
Cigna Setting Facility Modifier None Typical Low $70.79 Median $70.79 Typical High $70.79 | Facility | None | $70.79 | $70.79 | $70.79 |
Cigna Setting Professional Modifier None (both parts) Typical Low $51.29 Median $70.79 Typical High $70.79 | Professional | None (both parts) | $51.29 | $70.79 | $70.79 |
Medcost Setting Professional Modifier None Typical Low $45.71 Median $48.98 Typical High $64.57 | Professional | None | $45.71 | $48.98 | $64.57 |
Medcost Setting Facility Modifier None Typical Low $28.18 Median $87.10 Typical High $100.00 | Facility | None | $28.18 | $87.10 | $100.00 |
Medcost Setting Professional Modifier None (both parts) Typical Low $57.54 Median $72.44 Typical High $117.49 | Professional | None (both parts) | $57.54 | $72.44 | $117.49 |
United Setting Professional Modifier None (both parts) Typical Low $33.88 Median $48.98 Typical High $66.07 | Professional | None (both parts) | $33.88 | $48.98 | $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 $24.55 Median $43.65 Typical High $43.65 | Professional | 52 · Reduced service | $24.55 | $43.65 | $43.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.77 Median $17.38 Typical High $17.38 | Professional | 53 · Discontinued | $9.77 | $17.38 | $17.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.24 Median $12.88 Typical High $12.88 | Professional | 55 · Aftercare only | $7.24 | $12.88 | $12.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.90 Median $8.71 Typical High $8.71 | Professional | 56 · Pre-op care only | $4.90 | $8.71 | $8.71 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $28.84 Median $29.51 Typical High $66.07 | Professional | 26 · Professional part | $28.84 | $29.51 | $66.07 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $85.11 Median $107.15 Typical High $331.13 | Professional | 50 · Both sides | $85.11 | $107.15 | $331.13 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $28.18 Median $36.31 Typical High $112.20 | Professional | 51 · Multiple procedures | $28.18 | $36.31 | $112.20 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $11.48 Median $14.45 Typical High $44.67 | Professional | 80 · Assistant surgeon | $11.48 | $14.45 | $44.67 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $7.94 Median $10.00 Typical High $30.90 | Professional | 81 · Minimal assistant surgeon | $7.94 | $10.00 | $30.90 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $7.94 Median $10.00 Typical High $30.90 | Professional | 82 · Assistant surgeon, no resident | $7.94 | $10.00 | $30.90 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $7.94 Median $10.00 Typical High $30.90 | Professional | AS · PA/NP assist | $7.94 | $10.00 | $30.90 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | SH · Second concurrent infusion | $28.18 | $28.18 | $28.18 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | SJ · Third+ concurrent infusion | $28.18 | $28.18 | $28.18 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $43.65 Median $44.67 Typical High $100.00 | Professional | TC · Technical part | $43.65 | $44.67 | $100.00 |
Where North Carolina sits
The same service costs 2.0 times more in Hawaii than in West Virginia. 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· 16th of 51
$75.86
HI $102WV $51.29
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.