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 $67.61 Median $67.61 Typical High $67.61 | Facility | None | $67.61 | $67.61 | $67.61 |
Aetna Setting Professional Modifier None Typical Low $51.29 Median $67.61 Typical High $67.61 | Professional | None | $51.29 | $67.61 | $67.61 |
BCBS North Carolina Setting Facility Modifier None Typical Low $63.10 Median $63.10 Typical High $75.86 | Facility | None | $63.10 | $63.10 | $75.86 |
BCBS North Carolina Setting Professional Modifier None Typical Low $61.66 Median $77.62 Typical High $77.62 | Professional | None | $61.66 | $77.62 | $77.62 |
Cigna Setting Professional Modifier None Typical Low $28.84 Median $28.84 Typical High $43.65 | Professional | None | $28.84 | $28.84 | $43.65 |
Medcost Setting Facility Modifier None Typical Low $67.61 Median $67.61 Typical High $93.33 | Facility | None | $67.61 | $67.61 | $93.33 |
Medcost Setting Professional Modifier None Typical Low $51.29 Median $53.70 Typical High $57.54 | Professional | None | $51.29 | $53.70 | $57.54 |
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 $25.12 Typical High $38.90 | Professional | None | $10.00 | $25.12 | $38.90 |
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 $25.70 Median $33.88 Typical High $33.88 | Professional | 52 · Reduced service | $25.70 | $33.88 | $33.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $13.49 Typical High $13.49 | Professional | 53 · Discontinued | $10.23 | $13.49 | $13.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $10.00 Typical High $10.00 | Professional | 55 · Aftercare only | $7.76 | $10.00 | $10.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $6.76 Typical High $6.76 | Professional | 56 · Pre-op care only | $5.13 | $6.76 | $6.76 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $25.70 Median $26.92 Typical High $28.84 | Professional | 51 · Multiple procedures | $25.70 | $26.92 | $28.84 |
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 2.6 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· 2nd of 51
$70.79
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.