How much rates vary
Facilitymedian $17 · 10th to 90th $8 to $19Professionalmedian $20 · 10th to 90th $12 to $22
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 $19.05 Median $19.05 Typical High $19.05 | Facility | None | $19.05 | $19.05 | $19.05 |
Aetna Setting Professional Modifier None (both parts) Typical Low $13.18 Median $19.05 Typical High $19.05 | Professional | None (both parts) | $13.18 | $19.05 | $19.05 |
BCBS North Carolina Setting Facility Modifier None Typical Low $21.38 Median $21.38 Typical High $25.70 | Facility | None | $21.38 | $21.38 | $25.70 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $15.14 Median $19.95 Typical High $26.30 | Professional | None (both parts) | $15.14 | $19.95 | $26.30 |
Cigna Setting Facility Modifier None Typical Low $16.60 Median $16.60 Typical High $16.60 | Facility | None | $16.60 | $16.60 | $16.60 |
Cigna Setting Professional Modifier None (both parts) Typical Low $12.02 Median $16.60 Typical High $16.60 | Professional | None (both parts) | $12.02 | $16.60 | $16.60 |
Medcost Setting Professional Modifier None Typical Low $12.88 Median $13.80 Typical High $18.62 | Professional | None | $12.88 | $13.80 | $18.62 |
Medcost Setting Facility Modifier None Typical Low $7.94 Median $14.13 Typical High $21.38 | Facility | None | $7.94 | $14.13 | $21.38 |
Medcost Setting Professional Modifier None (both parts) Typical Low $15.14 Median $19.05 Typical High $30.90 | Professional | None (both parts) | $15.14 | $19.05 | $30.90 |
United Setting Facility Modifier None Typical Low $12.88 Median $12.88 Typical High $16.22 | Facility | None | $12.88 | $12.88 | $16.22 |
United Setting Professional Modifier None (both parts) Typical Low $10.00 Median $12.88 Typical High $18.62 | Professional | None (both parts) | $10.00 | $12.88 | $18.62 |
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 $6.76 Median $9.55 Typical High $9.55 | Professional | 52 · Reduced service | $6.76 | $9.55 | $9.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.75 Median $3.89 Typical High $3.89 | Professional | 53 · Discontinued | $2.75 | $3.89 | $3.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.04 Median $2.88 Typical High $2.88 | Professional | 55 · Aftercare only | $2.04 | $2.88 | $2.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.38 Median $1.95 Typical High $1.95 | Professional | 56 · Pre-op care only | $1.38 | $1.95 | $1.95 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $7.59 Median $7.76 Typical High $17.38 | Professional | 26 · Professional part | $7.59 | $7.76 | $17.38 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $22.39 Median $28.18 Typical High $87.10 | Professional | 50 · Both sides | $22.39 | $28.18 | $87.10 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $7.59 Median $9.55 Typical High $29.51 | Professional | 51 · Multiple procedures | $7.59 | $9.55 | $29.51 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $3.02 Median $3.80 Typical High $11.75 | Professional | 80 · Assistant surgeon | $3.02 | $3.80 | $11.75 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $2.09 Median $2.63 Typical High $8.13 | Professional | 81 · Minimal assistant surgeon | $2.09 | $2.63 | $8.13 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $2.09 Median $2.63 Typical High $8.13 | Professional | 82 · Assistant surgeon, no resident | $2.09 | $2.63 | $8.13 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $2.09 Median $2.63 Typical High $8.13 | Professional | AS · PA/NP assist | $2.09 | $2.63 | $8.13 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | SH · Second concurrent infusion | $7.59 | $7.59 | $7.59 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | SJ · Third+ concurrent infusion | $7.59 | $7.59 | $7.59 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $11.48 Median $11.75 Typical High $26.30 | Professional | TC · Technical part | $11.48 | $11.75 | $26.30 |
Where North Carolina sits
The same service costs 3.0 times more in Hawaii 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
$19.50
HI $36.31DE $12.02
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.