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 $35.48 Median $35.48 Typical High $35.48 | Facility | None | $35.48 | $35.48 | $35.48 |
Aetna Setting Professional Modifier None Typical Low $33.11 Median $35.48 Typical High $35.48 | Professional | None | $33.11 | $35.48 | $35.48 |
BCBS North Carolina Setting Facility Modifier None Typical Low $33.88 Median $33.88 Typical High $40.74 | Facility | None | $33.88 | $33.88 | $40.74 |
BCBS North Carolina Setting Professional Modifier None Typical Low $33.11 Median $41.69 Typical High $41.69 | Professional | None | $33.11 | $41.69 | $41.69 |
Cigna Setting Professional Modifier None Typical Low $19.95 Median $19.95 Typical High $30.90 | Professional | None | $19.95 | $19.95 | $30.90 |
Medcost Setting Facility Modifier None Typical Low $35.48 Median $35.48 Typical High $48.98 | Facility | None | $35.48 | $35.48 | $48.98 |
Medcost Setting Professional Modifier None Typical Low $26.92 Median $28.84 Typical High $30.90 | Professional | None | $26.92 | $28.84 | $30.90 |
Oscar Health Setting Professional Modifier None Typical Low $19.95 Median $25.12 Typical High $34.67 | Professional | None | $19.95 | $25.12 | $34.67 |
United Setting Professional Modifier None Typical Low $10.00 Median $15.49 Typical High $23.99 | Professional | None | $10.00 | $15.49 | $23.99 |
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 $16.60 Median $17.78 Typical High $17.78 | Professional | 52 · Reduced service | $16.60 | $17.78 | $17.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.61 Median $7.08 Typical High $7.08 | Professional | 53 · Discontinued | $6.61 | $7.08 | $7.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.90 Median $5.37 Typical High $5.37 | Professional | 55 · Aftercare only | $4.90 | $5.37 | $5.37 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.31 Median $3.55 Typical High $3.55 | Professional | 56 · Pre-op care only | $3.31 | $3.55 | $3.55 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $13.49 Median $14.45 Typical High $15.49 | Professional | 51 · Multiple procedures | $13.49 | $14.45 | $15.49 |
Oscar Health Setting Professional Modifier GX · Voluntary liability notice Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | GX · Voluntary liability notice | $15.14 | $15.14 | $15.14 |
Oscar Health Setting Professional Modifier LO Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | LO | $30.20 | $30.20 | $30.20 |
Oscar Health Setting Professional Modifier PL · Progressive lenses Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | PL · Progressive lenses | $15.14 | $15.14 | $15.14 |
Where North Carolina sits
The same service costs 3.2 times more in Montana than in Indiana. 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· 13th of 51
$38.02
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.