How much rates vary
Facilitymedian $4 · 10th to 90th $2 to $5Professionalmedian $5 · 10th to 90th $3 to $5
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 $4.68 Median $4.68 Typical High $4.68 | Facility | None | $4.68 | $4.68 | $4.68 |
Aetna Setting Professional Modifier None (both parts) Typical Low $3.09 Median $4.68 Typical High $4.68 | Professional | None (both parts) | $3.09 | $4.68 | $4.68 |
BCBS North Carolina Setting Professional Modifier None (both parts) Typical Low $4.79 Median $4.79 Typical High $5.37 | Professional | None (both parts) | $4.79 | $4.79 | $5.37 |
Cigna Setting Facility Modifier None Typical Low $3.55 Median $3.55 Typical High $3.55 | Facility | None | $3.55 | $3.55 | $3.55 |
Cigna Setting Professional Modifier None (both parts) Typical Low $2.95 Median $3.55 Typical High $3.55 | Professional | None (both parts) | $2.95 | $3.55 | $3.55 |
Medcost Setting Professional Modifier None Typical Low $2.95 Median $3.16 Typical High $4.07 | Professional | None | $2.95 | $3.16 | $4.07 |
Medcost Setting Facility Modifier None Typical Low $1.82 Median $4.68 Typical High $5.62 | Facility | None | $1.82 | $4.68 | $5.62 |
Medcost Setting Professional Modifier None (both parts) Typical Low $3.98 Median $4.47 Typical High $7.59 | Professional | None (both parts) | $3.98 | $4.47 | $7.59 |
United Setting Professional Modifier None (both parts) Typical Low $2.40 Median $3.16 Typical High $4.27 | Professional | None (both parts) | $2.40 | $3.16 | $4.27 |
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 $1.55 Median $2.34 Typical High $2.34 | Professional | 52 · Reduced service | $1.55 | $2.34 | $2.34 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.62 Median $0.93 Typical High $0.93 | Professional | 53 · Discontinued | $0.62 | $0.93 | $0.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.46 Median $0.71 Typical High $0.71 | Professional | 55 · Aftercare only | $0.46 | $0.71 | $0.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.31 Median $0.47 Typical High $0.47 | Professional | 56 · Pre-op care only | $0.31 | $0.47 | $0.47 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $1.78 Median $1.91 Typical High $4.27 | Professional | 26 · Professional part | $1.78 | $1.91 | $4.27 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $6.03 Median $6.61 Typical High $21.38 | Professional | 50 · Both sides | $6.03 | $6.61 | $21.38 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $2.00 Median $2.24 Typical High $7.08 | Professional | 51 · Multiple procedures | $2.00 | $2.24 | $7.08 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $0.79 Median $0.89 Typical High $2.88 | Professional | 80 · Assistant surgeon | $0.79 | $0.89 | $2.88 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $0.56 Median $0.62 Typical High $2.00 | Professional | 81 · Minimal assistant surgeon | $0.56 | $0.62 | $2.00 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $0.56 Median $0.62 Typical High $2.00 | Professional | 82 · Assistant surgeon, no resident | $0.56 | $0.62 | $2.00 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $0.56 Median $0.62 Typical High $2.00 | Professional | AS · PA/NP assist | $0.56 | $0.62 | $2.00 |
Medcost Setting Professional Modifier SH · Second concurrent infusion Typical Low $2.00 Median $2.00 Typical High $2.00 | Professional | SH · Second concurrent infusion | $2.00 | $2.00 | $2.00 |
Medcost Setting Professional Modifier SJ · Third+ concurrent infusion Typical Low $2.00 Median $2.00 Typical High $2.00 | Professional | SJ · Third+ concurrent infusion | $2.00 | $2.00 | $2.00 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $2.63 Median $2.82 Typical High $6.46 | Professional | TC · Technical part | $2.63 | $2.82 | $6.46 |
Where North Carolina sits
The same service costs 4.9 times more in Kansas 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· 16th of 51
$4.79
KS $14.45DE $2.95
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.