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 $13.18 Median $13.18 Typical High $13.18 | Facility | None | $13.18 | $13.18 | $13.18 |
Aetna Setting Professional Modifier None Typical Low $10.96 Median $13.18 Typical High $15.49 | Professional | None | $10.96 | $13.18 | $15.49 |
Ambetter Setting Professional Modifier None Typical Low $12.30 Median $26.92 Typical High $26.92 | Professional | None | $12.30 | $26.92 | $26.92 |
BCBS North Carolina Setting Professional Modifier None Typical Low $11.22 Median $11.75 Typical High $12.30 | Professional | None | $11.22 | $11.75 | $12.30 |
Cigna Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $6.31 | Professional | None | $6.31 | $6.31 | $6.31 |
Medcost Setting Facility Modifier None Typical Low $13.18 Median $18.62 Typical High $112.20 | Facility | None | $13.18 | $18.62 | $112.20 |
Medcost Setting Professional Modifier None Typical Low $12.02 Median $17.78 Typical High $29.51 | Professional | None | $12.02 | $17.78 | $29.51 |
United Setting Professional Modifier None Typical Low $5.37 Median $7.24 Typical High $8.32 | Professional | None | $5.37 | $7.24 | $8.32 |
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 $5.25 Median $6.61 Typical High $6.61 | Professional | 52 · Reduced service | $5.25 | $6.61 | $6.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.14 Median $2.63 Typical High $2.63 | Professional | 53 · Discontinued | $2.14 | $2.63 | $2.63 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $7.94 Median $10.00 Typical High $10.00 | Professional | 54 · Surgery only | $7.94 | $10.00 | $10.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.58 Median $2.00 Typical High $2.00 | Professional | 55 · Aftercare only | $1.58 | $2.00 | $2.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.07 Median $1.32 Typical High $1.32 | Professional | 56 · Pre-op care only | $1.07 | $1.32 | $1.32 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $6.03 Median $14.79 Typical High $18.20 | Professional | 51 · Multiple procedures | $6.03 | $14.79 | $18.20 |
Where North Carolina sits
The same service costs 4.5 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· 24th of 51
$11.75
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.