How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $0.87 Median $0.87 Typical High $0.87 | Facility | None | $0.87 | $0.87 | $0.87 |
Aetna Setting Professional Modifier None Typical Low $0.83 Median $0.87 Typical High $0.87 | Professional | None | $0.83 | $0.87 | $0.87 |
BCBS North Carolina Setting Professional Modifier None Typical Low $45.71 Median $60.26 Typical High $100.00 | Professional | None | $45.71 | $60.26 | $100.00 |
Cigna Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $56.23 | Professional | None | $56.23 | $56.23 | $56.23 |
Medcost Setting Facility Modifier None Typical Low $0.87 Median $0.91 Typical High $1.38 | Facility | None | $0.87 | $0.91 | $1.38 |
Medcost Setting Professional Modifier None Typical Low $0.98 Median $0.98 Typical High $1.02 | Professional | None | $0.98 | $0.98 | $1.02 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $0.25 Median $0.48 Typical High $0.48 | Professional | 51 · Multiple procedures | $0.25 | $0.48 | $0.48 |
4 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 $0.42 Median $0.44 Typical High $0.44 | Professional | 52 · Reduced service | $0.42 | $0.44 | $0.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.17 Median $0.17 Typical High $0.17 | Professional | 53 · Discontinued | $0.17 | $0.17 | $0.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.13 Median $0.13 Typical High $0.13 | Professional | 55 · Aftercare only | $0.13 | $0.13 | $0.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.08 Median $0.09 Typical High $0.09 | Professional | 56 · Pre-op care only | $0.08 | $0.09 | $0.09 |
Where North Carolina sits
The same service costs 173.8 times more in Missouri than in Illinois. 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
$45.71
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.