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 $39.81 Median $39.81 Typical High $39.81 | Facility | None | $39.81 | $39.81 | $39.81 |
Aetna Setting Professional Modifier None Typical Low $36.31 Median $39.81 Typical High $39.81 | Professional | None | $36.31 | $39.81 | $39.81 |
BCBS North Carolina Setting Facility Modifier None Typical Low $37.15 Median $37.15 Typical High $44.67 | Facility | None | $37.15 | $37.15 | $44.67 |
BCBS North Carolina Setting Professional Modifier None Typical Low $36.31 Median $45.71 Typical High $45.71 | Professional | None | $36.31 | $45.71 | $45.71 |
Cigna Setting Professional Modifier None Typical Low $22.39 Median $22.39 Typical High $33.88 | Professional | None | $22.39 | $22.39 | $33.88 |
Medcost Setting Facility Modifier None Typical Low $39.81 Median $39.81 Typical High $54.95 | Facility | None | $39.81 | $39.81 | $54.95 |
Medcost Setting Professional Modifier None Typical Low $30.20 Median $32.36 Typical High $33.88 | Professional | None | $30.20 | $32.36 | $33.88 |
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 $17.38 Typical High $25.12 | Professional | None | $10.00 | $17.38 | $25.12 |
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 $18.20 Median $19.95 Typical High $19.95 | Professional | 52 · Reduced service | $18.20 | $19.95 | $19.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.24 Median $7.94 Typical High $7.94 | Professional | 53 · Discontinued | $7.24 | $7.94 | $7.94 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $5.89 Typical High $5.89 | Professional | 55 · Aftercare only | $5.50 | $5.89 | $5.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.63 Median $3.98 Typical High $3.98 | Professional | 56 · Pre-op care only | $3.63 | $3.98 | $3.98 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $15.14 Median $15.85 Typical High $16.98 | Professional | 51 · Multiple procedures | $15.14 | $15.85 | $16.98 |
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 3.3 times more in Montana than in Missouri. 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· 11th of 51
$41.69
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.