How much rates vary
Facilitymedian $5 · 10th to 90th $3 to $6Professionalmedian $6 · 10th to 90th $4 to $7
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 $6.03 Median $6.03 Typical High $6.03 | Facility | None | $6.03 | $6.03 | $6.03 |
Aetna Setting Professional Modifier None (both parts) Typical Low $3.89 Median $6.03 Typical High $6.03 | Professional | None (both parts) | $3.89 | $6.03 | $6.03 |
Ambetter Setting Professional Modifier None (both parts) Typical Low $6.17 Median $6.17 Typical High $6.17 | Professional | None (both parts) | $6.17 | $6.17 | $6.17 |
BCBS North Carolina Setting Facility Modifier None Typical Low $6.61 Median $6.61 Typical High $7.94 | Facility | None | $6.61 | $6.61 | $7.94 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $5.89 Median $6.17 Typical High $8.13 | Professional | None (both parts) | $5.89 | $6.17 | $8.13 |
Cigna Setting Facility Modifier None Typical Low $5.13 Median $5.13 Typical High $5.13 | Facility | None | $5.13 | $5.13 | $5.13 |
Cigna Setting Professional Modifier None (both parts) Typical Low $3.80 Median $5.13 Typical High $5.13 | Professional | None (both parts) | $3.80 | $5.13 | $5.13 |
Medcost Setting Professional Modifier None Typical Low $4.47 Median $4.79 Typical High $5.37 | Professional | None | $4.47 | $4.79 | $5.37 |
Medcost Setting Facility Modifier None Typical Low $2.57 Median $4.37 Typical High $6.61 | Facility | None | $2.57 | $4.37 | $6.61 |
Medcost Setting Professional Modifier None (both parts) Typical Low $5.01 Median $6.03 Typical High $9.55 | Professional | None (both parts) | $5.01 | $6.03 | $9.55 |
United Setting Facility Modifier None Typical Low $4.79 Median $4.79 Typical High $5.37 | Facility | None | $4.79 | $4.79 | $5.37 |
United Setting Professional Modifier None (both parts) Typical Low $3.09 Median $3.98 Typical High $6.03 | Professional | None (both parts) | $3.09 | $3.98 | $6.03 |
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 $1.95 Median $2.95 Typical High $2.95 | Professional | 52 · Reduced service | $1.95 | $2.95 | $2.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.79 Median $1.20 Typical High $1.20 | Professional | 53 · Discontinued | $0.79 | $1.20 | $1.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.59 Median $0.89 Typical High $0.89 | Professional | 55 · Aftercare only | $0.59 | $0.89 | $0.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.39 Median $0.60 Typical High $0.60 | Professional | 56 · Pre-op care only | $0.39 | $0.60 | $0.60 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $2.40 Median $2.40 Typical High $5.37 | Professional | 26 · Professional part | $2.40 | $2.40 | $5.37 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $7.59 Median $8.91 Typical High $26.92 | Professional | 50 · Both sides | $7.59 | $8.91 | $26.92 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $2.51 Median $3.02 Typical High $9.12 | Professional | 51 · Multiple procedures | $2.51 | $3.02 | $9.12 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $1.00 Median $1.20 Typical High $3.63 | Professional | 80 · Assistant surgeon | $1.00 | $1.20 | $3.63 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $0.71 Median $0.83 Typical High $2.51 | Professional | 81 · Minimal assistant surgeon | $0.71 | $0.83 | $2.51 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $0.71 Median $0.83 Typical High $2.51 | Professional | 82 · Assistant surgeon, no resident | $0.71 | $0.83 | $2.51 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $0.71 Median $0.83 Typical High $2.51 | Professional | AS · PA/NP assist | $0.71 | $0.83 | $2.51 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $2.51 Median $2.51 Typical High $2.51 | Professional | SH · Second concurrent infusion | $2.51 | $2.51 | $2.51 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $2.51 Median $2.51 Typical High $2.51 | Professional | SJ · Third+ concurrent infusion | $2.51 | $2.51 | $2.51 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $3.63 Median $3.63 Typical High $8.13 | Professional | TC · Technical part | $3.63 | $3.63 | $8.13 |
Where North Carolina sits
The same service costs 3.2 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· 20th of 51
$6.17
HI $12.02DE $3.80
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.