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 $22.91 Median $22.91 Typical High $22.91 | Facility | None | $22.91 | $22.91 | $22.91 |
Aetna Setting Professional Modifier None Typical Low $15.85 Median $22.91 Typical High $22.91 | Professional | None | $15.85 | $22.91 | $22.91 |
BCBS North Carolina Setting Facility Modifier None Typical Low $21.88 Median $21.88 Typical High $26.30 | Facility | None | $21.88 | $21.88 | $26.30 |
BCBS North Carolina Setting Professional Modifier None Typical Low $21.38 Median $26.92 Typical High $26.92 | Professional | None | $21.38 | $26.92 | $26.92 |
Cigna Setting Professional Modifier None Typical Low $9.55 Median $9.55 Typical High $18.62 | Professional | None | $9.55 | $9.55 | $18.62 |
Medcost Setting Facility Modifier None Typical Low $22.91 Median $22.91 Typical High $31.62 | Facility | None | $22.91 | $22.91 | $31.62 |
Medcost Setting Professional Modifier None Typical Low $17.38 Median $19.05 Typical High $19.95 | Professional | None | $17.38 | $19.05 | $19.95 |
Oscar Health Setting Professional Modifier None Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | None | $10.00 | $10.00 | $10.00 |
United Setting Professional Modifier None Typical Low $6.61 Median $10.00 Typical High $16.98 | Professional | None | $6.61 | $10.00 | $16.98 |
8 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 $7.76 Median $11.48 Typical High $11.48 | Professional | 52 · Reduced service | $7.76 | $11.48 | $11.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.09 Median $4.57 Typical High $4.57 | Professional | 53 · Discontinued | $3.09 | $4.57 | $4.57 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.29 Median $3.47 Typical High $3.47 | Professional | 55 · Aftercare only | $2.29 | $3.47 | $3.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.55 Median $2.29 Typical High $2.29 | Professional | 56 · Pre-op care only | $1.55 | $2.29 | $2.29 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $8.71 Median $9.55 Typical High $9.77 | Professional | 51 · Multiple procedures | $8.71 | $9.55 | $9.77 |
Oscar Health Setting Professional Modifier MV Typical Low $25.12 Median $25.12 Typical High $64.57 | Professional | MV | $25.12 | $25.12 | $64.57 |
Oscar Health Setting Professional Modifier SM · Second surgical opinion Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | SM · Second surgical opinion | $10.00 | $10.00 | $10.00 |
Oscar Health Setting Professional Modifier SV · Delivered, not used Typical Low $25.12 Median $25.12 Typical High $64.57 | Professional | SV · Delivered, not used | $25.12 | $25.12 | $64.57 |
Where North Carolina sits
The same service costs 3.0 times more in Montana 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· 2nd of 51
$24.55
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.