How much rates vary
Facilitymedian $19 · 10th to 90th $9 to $25Professionalmedian $25 · 10th to 90th $15 to $28
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 $24.55 Median $24.55 Typical High $24.55 | Facility | None | $24.55 | $24.55 | $24.55 |
Aetna Setting Professional Modifier None (both parts) Typical Low $14.13 Median $24.55 Typical High $24.55 | Professional | None (both parts) | $14.13 | $24.55 | $24.55 |
Ambetter Setting Professional Modifier None (both parts) Typical Low $25.12 Median $30.20 Typical High $35.48 | Professional | None (both parts) | $25.12 | $30.20 | $35.48 |
BCBS North Carolina Setting Facility Modifier None Typical Low $27.54 Median $27.54 Typical High $33.11 | Facility | None | $27.54 | $27.54 | $33.11 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $19.05 Median $25.12 Typical High $33.88 | Professional | None (both parts) | $19.05 | $25.12 | $33.88 |
Cigna Setting Facility Modifier None Typical Low $18.62 Median $18.62 Typical High $18.62 | Facility | None | $18.62 | $18.62 | $18.62 |
Cigna Setting Professional Modifier None (both parts) Typical Low $13.49 Median $18.62 Typical High $19.05 | Professional | None (both parts) | $13.49 | $18.62 | $19.05 |
Medcost Setting Professional Modifier None Typical Low $12.88 Median $13.80 Typical High $17.78 | Professional | None | $12.88 | $13.80 | $17.78 |
Medcost Setting Facility Modifier None Typical Low $8.51 Median $18.20 Typical High $26.92 | Facility | None | $8.51 | $18.20 | $26.92 |
Medcost Setting Professional Modifier None (both parts) Typical Low $19.05 Median $23.99 Typical High $39.81 | Professional | None (both parts) | $19.05 | $23.99 | $39.81 |
United Setting Facility Modifier None Typical Low $14.45 Median $14.45 Typical High $16.60 | Facility | None | $14.45 | $14.45 | $16.60 |
United Setting Professional Modifier None (both parts) Typical Low $12.59 Median $16.60 Typical High $20.42 | Professional | None (both parts) | $12.59 | $16.60 | $20.42 |
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 $7.08 Median $12.30 Typical High $12.30 | Professional | 52 · Reduced service | $7.08 | $12.30 | $12.30 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.82 Median $4.90 Typical High $4.90 | Professional | 53 · Discontinued | $2.82 | $4.90 | $4.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.14 Median $3.72 Typical High $3.72 | Professional | 55 · Aftercare only | $2.14 | $3.72 | $3.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.41 Median $2.45 Typical High $2.45 | Professional | 56 · Pre-op care only | $1.41 | $2.45 | $2.45 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $9.55 Median $10.00 Typical High $22.39 | Professional | 26 · Professional part | $9.55 | $10.00 | $22.39 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $28.18 Median $36.31 Typical High $112.20 | Professional | 50 · Both sides | $28.18 | $36.31 | $112.20 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $9.55 Median $12.02 Typical High $37.15 | Professional | 51 · Multiple procedures | $9.55 | $12.02 | $37.15 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $3.80 Median $4.79 Typical High $14.79 | Professional | 80 · Assistant surgeon | $3.80 | $4.79 | $14.79 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $2.63 Median $3.39 Typical High $10.47 | Professional | 81 · Minimal assistant surgeon | $2.63 | $3.39 | $10.47 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $2.63 Median $3.39 Typical High $10.47 | Professional | 82 · Assistant surgeon, no resident | $2.63 | $3.39 | $10.47 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $2.63 Median $3.39 Typical High $10.47 | Professional | AS · PA/NP assist | $2.63 | $3.39 | $10.47 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | SH · Second concurrent infusion | $9.55 | $9.55 | $9.55 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | SJ · Third+ concurrent infusion | $9.55 | $9.55 | $9.55 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $14.45 Median $14.79 Typical High $33.11 | Professional | TC · Technical part | $14.45 | $14.79 | $33.11 |
Where North Carolina sits
The same service costs 2.8 times more in Hawaii than in Pennsylvania. 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· 12th of 51
$25.12
HI $37.15PA $13.49
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.