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 $3.72 Median $3.72 Typical High $3.72 | Facility | None | $3.72 | $3.72 | $3.72 |
Aetna Setting Professional Modifier None Typical Low $2.95 Median $3.72 Typical High $3.72 | Professional | None | $2.95 | $3.72 | $3.72 |
BCBS North Carolina Setting Facility Modifier None Typical Low $6.76 Median $6.76 Typical High $8.13 | Facility | None | $6.76 | $6.76 | $8.13 |
BCBS North Carolina Setting Professional Modifier None Typical Low $2.75 Median $3.24 Typical High $3.47 | Professional | None | $2.75 | $3.24 | $3.47 |
Cigna Setting Professional Modifier None Typical Low $1.78 Median $1.78 Typical High $1.78 | Professional | None | $1.78 | $1.78 | $1.78 |
Medcost Setting Facility Modifier None Typical Low $3.72 Median $5.13 Typical High $25.70 | Facility | None | $3.72 | $5.13 | $25.70 |
Medcost Setting Professional Modifier None Typical Low $3.09 Median $7.08 Typical High $10.96 | Professional | None | $3.09 | $7.08 | $10.96 |
United Setting Professional Modifier None Typical Low $1.51 Median $2.04 Typical High $2.34 | Professional | None | $1.51 | $2.04 | $2.34 |
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 $1.48 Median $1.86 Typical High $1.86 | Professional | 52 · Reduced service | $1.48 | $1.86 | $1.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.59 Median $0.74 Typical High $0.74 | Professional | 53 · Discontinued | $0.59 | $0.74 | $0.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.19 Median $2.75 Typical High $2.75 | Professional | 54 · Surgery only | $2.19 | $2.75 | $2.75 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.44 Median $0.56 Typical High $0.56 | Professional | 55 · Aftercare only | $0.44 | $0.56 | $0.56 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.30 Median $0.37 Typical High $0.37 | Professional | 56 · Pre-op care only | $0.30 | $0.37 | $0.37 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $1.55 Median $3.47 Typical High $5.50 | Professional | 51 · Multiple procedures | $1.55 | $3.47 | $5.50 |
Where North Carolina sits
The same service costs 4.0 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
$3.24
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.