How much rates vary
Facilitymedian $21 · 10th to 90th $6 to $21Professionalmedian $9 · 10th to 90th $7 to $21
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 $11.75 Median $11.75 Typical High $11.75 | Facility | None | $11.75 | $11.75 | $11.75 |
Aetna Setting Professional Modifier None (both parts) Typical Low $6.61 Median $11.75 Typical High $13.18 | Professional | None (both parts) | $6.61 | $11.75 | $13.18 |
Ambetter Setting Professional Modifier None (both parts) Typical Low $7.41 Median $10.23 Typical High $19.95 | Professional | None (both parts) | $7.41 | $10.23 | $19.95 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $8.32 Median $8.71 Typical High $11.48 | Professional | None (both parts) | $8.32 | $8.71 | $11.48 |
Cigna Setting Facility Modifier None Typical Low $20.89 Median $20.89 Typical High $21.38 | Facility | None | $20.89 | $20.89 | $21.38 |
Cigna Setting Professional Modifier None (both parts) Typical Low $15.49 Median $20.89 Typical High $20.89 | Professional | None (both parts) | $15.49 | $20.89 | $20.89 |
Medcost Setting Facility Modifier None Typical Low $6.17 Median $11.75 Typical High $14.13 | Facility | None | $6.17 | $11.75 | $14.13 |
Medcost Setting Professional Modifier None (both parts) Typical Low $11.75 Median $30.90 Typical High $30.90 | Professional | None (both parts) | $11.75 | $30.90 | $30.90 |
United Setting Professional Modifier None (both parts) Typical Low $5.01 Median $7.41 Typical High $10.96 | Professional | None (both parts) | $5.01 | $7.41 | $10.96 |
16 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 $3.63 Median $5.89 Typical High $5.89 | Professional | 52 · Reduced service | $3.63 | $5.89 | $5.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.45 Median $2.40 Typical High $2.40 | Professional | 53 · Discontinued | $1.45 | $2.40 | $2.40 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.07 Median $1.78 Typical High $1.78 | Professional | 55 · Aftercare only | $1.07 | $1.78 | $1.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.72 Median $1.20 Typical High $1.20 | Professional | 56 · Pre-op care only | $0.72 | $1.20 | $1.20 |
Ambetter Setting Professional Modifier GY · Excluded by law Typical Low $8.71 Median $8.71 Typical High $8.71 | Professional | GY · Excluded by law | $8.71 | $8.71 | $8.71 |
Cigna Setting Professional Modifier RR · Rental Typical Low $2.09 Median $2.09 Typical High $2.09 | Professional | RR · Rental | $2.09 | $2.09 | $2.09 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $4.68 Median $7.76 Typical High $12.30 | Professional | 26 · Professional part | $4.68 | $7.76 | $12.30 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $17.38 Median $46.77 Typical High $46.77 | Professional | 50 · Both sides | $17.38 | $46.77 | $46.77 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $5.89 Median $15.49 Typical High $15.49 | Professional | 51 · Multiple procedures | $5.89 | $15.49 | $15.49 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $2.34 Median $6.17 Typical High $6.17 | Professional | 80 · Assistant surgeon | $2.34 | $6.17 | $6.17 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $1.62 Median $4.37 Typical High $4.37 | Professional | 81 · Minimal assistant surgeon | $1.62 | $4.37 | $4.37 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $1.62 Median $4.37 Typical High $4.37 | Professional | 82 · Assistant surgeon, no resident | $1.62 | $4.37 | $4.37 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $1.62 Median $4.37 Typical High $4.37 | Professional | AS · PA/NP assist | $1.62 | $4.37 | $4.37 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $15.49 Median $15.49 Typical High $15.49 | Professional | SH · Second concurrent infusion | $15.49 | $15.49 | $15.49 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $15.49 Median $15.49 Typical High $15.49 | Professional | SJ · Third+ concurrent infusion | $15.49 | $15.49 | $15.49 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $7.08 Median $11.75 Typical High $18.62 | Professional | TC · Technical part | $7.08 | $11.75 | $18.62 |
Where North Carolina sits
The same service costs 6.2 times more in Wyoming than in North Carolina. 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· 51st of 51
$8.71
WY $53.70NC $8.71
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.