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 $14.13 Median $14.13 Typical High $14.13 | Facility | None | $14.13 | $14.13 | $14.13 |
Aetna Setting Professional Modifier None Typical Low $11.22 Median $14.13 Typical High $14.13 | Professional | None | $11.22 | $14.13 | $14.13 |
BCBS North Carolina Setting Professional Modifier None Typical Low $10.72 Median $12.30 Typical High $13.18 | Professional | None | $10.72 | $12.30 | $13.18 |
Cigna Setting Professional Modifier None Typical Low $6.76 Median $6.76 Typical High $6.76 | Professional | None | $6.76 | $6.76 | $6.76 |
Medcost Setting Facility Modifier None Typical Low $14.13 Median $19.50 Typical High $83.18 | Facility | None | $14.13 | $19.50 | $83.18 |
Medcost Setting Professional Modifier None Typical Low $16.22 Median $21.88 Typical High $41.69 | Professional | None | $16.22 | $21.88 | $41.69 |
United Setting Professional Modifier None Typical Low $5.75 Median $7.76 Typical High $8.91 | Professional | None | $5.75 | $7.76 | $8.91 |
6 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 $5.62 Median $7.08 Typical High $7.08 | Professional | 52 · Reduced service | $5.62 | $7.08 | $7.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.24 Median $2.82 Typical High $2.82 | Professional | 53 · Discontinued | $2.24 | $2.82 | $2.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $8.51 Median $10.72 Typical High $10.72 | Professional | 54 · Surgery only | $8.51 | $10.72 | $10.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.70 Median $2.14 Typical High $2.14 | Professional | 55 · Aftercare only | $1.70 | $2.14 | $2.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.12 Median $1.41 Typical High $1.41 | Professional | 56 · Pre-op care only | $1.12 | $1.41 | $1.41 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $10.96 Median $12.30 Typical High $20.89 | Professional | 51 · Multiple procedures | $10.96 | $12.30 | $20.89 |
Where North Carolina sits
The same service costs 3.2 times more in Rhode Island than in New York. 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· 21st of 51
$12.30
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.