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 $77.62 Median $77.62 Typical High $77.62 | Facility | None | $77.62 | $77.62 | $77.62 |
Aetna Setting Professional Modifier None Typical Low $70.79 Median $77.62 Typical High $77.62 | Professional | None | $70.79 | $77.62 | $77.62 |
BCBS North Carolina Setting Facility Modifier None Typical Low $72.44 Median $72.44 Typical High $87.10 | Facility | None | $72.44 | $72.44 | $87.10 |
BCBS North Carolina Setting Professional Modifier None Typical Low $70.79 Median $89.13 Typical High $89.13 | Professional | None | $70.79 | $89.13 | $89.13 |
Cigna Setting Professional Modifier None Typical Low $42.66 Median $42.66 Typical High $69.18 | Professional | None | $42.66 | $42.66 | $69.18 |
Medcost Setting Facility Modifier None Typical Low $77.62 Median $77.62 Typical High $107.15 | Facility | None | $77.62 | $77.62 | $107.15 |
Medcost Setting Professional Modifier None Typical Low $58.88 Median $61.66 Typical High $66.07 | Professional | None | $58.88 | $61.66 | $66.07 |
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 $29.51 Typical High $44.67 | Professional | None | $10.00 | $29.51 | $44.67 |
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 $35.48 Median $38.90 Typical High $38.90 | Professional | 52 · Reduced service | $35.48 | $38.90 | $38.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.13 Median $15.49 Typical High $15.49 | Professional | 53 · Discontinued | $14.13 | $15.49 | $15.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.72 Median $11.48 Typical High $11.48 | Professional | 55 · Aftercare only | $10.72 | $11.48 | $11.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.08 Median $7.76 Typical High $7.76 | Professional | 56 · Pre-op care only | $7.08 | $7.76 | $7.76 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $29.51 Median $30.90 Typical High $33.11 | Professional | 51 · Multiple procedures | $29.51 | $30.90 | $33.11 |
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 Hawaii 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· 9th of 51
$81.28
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.