How much rates vary
Facilitymedian $46 · 10th to 90th $21 to $58Professionalmedian $50 · 10th to 90th $31 to $60
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 $57.54 Median $57.54 Typical High $57.54 | Facility | None | $57.54 | $57.54 | $57.54 |
Aetna Setting Professional Modifier None (both parts) Typical Low $32.36 Median $57.54 Typical High $58.88 | Professional | None (both parts) | $32.36 | $57.54 | $58.88 |
Ambetter Setting Professional Modifier None (both parts) Typical Low $38.90 Median $50.12 Typical High $70.79 | Professional | None (both parts) | $38.90 | $50.12 | $70.79 |
BCBS North Carolina Setting Facility Modifier None Typical Low $54.95 Median $54.95 Typical High $66.07 | Facility | None | $54.95 | $54.95 | $66.07 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $43.65 Median $50.12 Typical High $53.70 | Professional | None (both parts) | $43.65 | $50.12 | $53.70 |
Cigna Setting Facility Modifier None Typical Low $45.71 Median $45.71 Typical High $45.71 | Facility | None | $45.71 | $45.71 | $45.71 |
Cigna Setting Professional Modifier None (both parts) Typical Low $33.11 Median $45.71 Typical High $45.71 | Professional | None (both parts) | $33.11 | $45.71 | $45.71 |
Medcost Setting Professional Modifier None Typical Low $30.90 Median $33.11 Typical High $50.12 | Professional | None | $30.90 | $33.11 | $50.12 |
Medcost Setting Facility Modifier None Typical Low $21.38 Median $36.31 Typical High $63.10 | Facility | None | $21.38 | $36.31 | $63.10 |
Medcost Setting Professional Modifier None (both parts) Typical Low $25.12 Median $37.15 Typical High $79.43 | Professional | None (both parts) | $25.12 | $37.15 | $79.43 |
Oscar Health Setting Facility Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Facility | None | $407.38 | $407.38 | $407.38 |
United Setting Facility Modifier None Typical Low $43.65 Median $43.65 Typical High $52.48 | Facility | None | $43.65 | $43.65 | $52.48 |
United Setting Professional Modifier None (both parts) Typical Low $25.12 Median $33.11 Typical High $46.77 | Professional | None (both parts) | $25.12 | $33.11 | $46.77 |
15 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 $18.20 Median $28.84 Typical High $28.84 | Professional | 52 · Reduced service | $18.20 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $11.48 Typical High $11.48 | Professional | 53 · Discontinued | $7.41 | $11.48 | $11.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $8.71 Typical High $8.71 | Professional | 55 · Aftercare only | $5.50 | $8.71 | $8.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.63 Median $5.75 Typical High $5.75 | Professional | 56 · Pre-op care only | $3.63 | $5.75 | $5.75 |
Cigna Setting Professional Modifier RR · Rental Typical Low $4.57 Median $4.57 Typical High $4.57 | Professional | RR · Rental | $4.57 | $4.57 | $4.57 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $10.00 Median $19.95 Typical High $44.67 | Professional | 26 · Professional part | $10.00 | $19.95 | $44.67 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $37.15 Median $54.95 Typical High $223.87 | Professional | 50 · Both sides | $37.15 | $54.95 | $223.87 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $12.59 Median $18.62 Typical High $74.13 | Professional | 51 · Multiple procedures | $12.59 | $18.62 | $74.13 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $5.01 Median $7.41 Typical High $29.51 | Professional | 80 · Assistant surgeon | $5.01 | $7.41 | $29.51 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $3.47 Median $5.13 Typical High $20.89 | Professional | 81 · Minimal assistant surgeon | $3.47 | $5.13 | $20.89 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $3.47 Median $5.13 Typical High $20.89 | Professional | 82 · Assistant surgeon, no resident | $3.47 | $5.13 | $20.89 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $3.47 Median $5.13 Typical High $20.89 | Professional | AS · PA/NP assist | $3.47 | $5.13 | $20.89 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $18.62 Median $18.62 Typical High $18.62 | Professional | SH · Second concurrent infusion | $18.62 | $18.62 | $18.62 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $18.62 Median $18.62 Typical High $18.62 | Professional | SJ · Third+ concurrent infusion | $18.62 | $18.62 | $18.62 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $15.14 Median $29.51 Typical High $66.07 | Professional | TC · Technical part | $15.14 | $29.51 | $66.07 |
Where North Carolina sits
The same service costs 3.8 times more in Hawaii than in Florida. 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· 24th of 51
$50.12
HI $126FL $33.11
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.