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 $10.23 Median $10.23 Typical High $10.23 | Facility | None | $10.23 | $10.23 | $10.23 |
Aetna Setting Professional Modifier None Typical Low $7.41 Median $10.23 Typical High $10.23 | Professional | None | $7.41 | $10.23 | $10.23 |
BCBS North Carolina Setting Facility Modifier None Typical Low $18.62 Median $18.62 Typical High $22.39 | Facility | None | $18.62 | $18.62 | $22.39 |
BCBS North Carolina Setting Professional Modifier None Typical Low $7.59 Median $8.91 Typical High $9.55 | Professional | None | $7.59 | $8.91 | $9.55 |
Cigna Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | None | $4.90 | $4.90 | $4.90 |
Medcost Setting Facility Modifier None Typical Low $10.23 Median $14.13 Typical High $51.29 | Facility | None | $10.23 | $14.13 | $51.29 |
Medcost Setting Professional Modifier None Typical Low $7.76 Median $13.80 Typical High $19.50 | Professional | None | $7.76 | $13.80 | $19.50 |
United Setting Professional Modifier None Typical Low $4.17 Median $5.62 Typical High $6.46 | Professional | None | $4.17 | $5.62 | $6.46 |
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 $4.07 Median $5.13 Typical High $5.13 | Professional | 52 · Reduced service | $4.07 | $5.13 | $5.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.62 Median $2.04 Typical High $2.04 | Professional | 53 · Discontinued | $1.62 | $2.04 | $2.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $6.03 Median $7.59 Typical High $7.59 | Professional | 54 · Surgery only | $6.03 | $7.59 | $7.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.23 Median $1.51 Typical High $1.51 | Professional | 55 · Aftercare only | $1.23 | $1.51 | $1.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.81 Median $1.02 Typical High $1.02 | Professional | 56 · Pre-op care only | $0.81 | $1.02 | $1.02 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $3.89 Median $6.92 Typical High $13.80 | Professional | 51 · Multiple procedures | $3.89 | $6.92 | $13.80 |
Where North Carolina sits
The same service costs 2.9 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
$8.91
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.