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 $72.44 Median $72.44 Typical High $72.44 | Facility | None | $72.44 | $72.44 | $72.44 |
Aetna Setting Professional Modifier None Typical Low $66.07 Median $72.44 Typical High $72.44 | Professional | None | $66.07 | $72.44 | $72.44 |
BCBS North Carolina Setting Facility Modifier None Typical Low $69.18 Median $69.18 Typical High $83.18 | Facility | None | $69.18 | $69.18 | $83.18 |
BCBS North Carolina Setting Professional Modifier None Typical Low $67.61 Median $85.11 Typical High $85.11 | Professional | None | $67.61 | $85.11 | $85.11 |
Cigna Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $58.88 | Professional | None | $38.02 | $38.02 | $58.88 |
Medcost Setting Facility Modifier None Typical Low $72.44 Median $72.44 Typical High $102.33 | Facility | None | $72.44 | $72.44 | $102.33 |
Medcost Setting Professional Modifier None Typical Low $56.23 Median $58.88 Typical High $63.10 | Professional | None | $56.23 | $58.88 | $63.10 |
Oscar Health Setting Professional Modifier None Typical Low $34.67 Median $39.81 Typical High $54.95 | Professional | None | $34.67 | $39.81 | $54.95 |
United Setting Professional Modifier None Typical Low $12.88 Median $30.20 Typical High $41.69 | Professional | None | $12.88 | $30.20 | $41.69 |
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 $33.11 Median $36.31 Typical High $36.31 | Professional | 52 · Reduced service | $33.11 | $36.31 | $36.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $14.79 Typical High $14.79 | Professional | 53 · Discontinued | $13.18 | $14.79 | $14.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $10.96 Typical High $10.96 | Professional | 55 · Aftercare only | $10.00 | $10.96 | $10.96 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $7.24 Typical High $7.24 | Professional | 56 · Pre-op care only | $6.61 | $7.24 | $7.24 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $27.54 Median $29.51 Typical High $31.62 | Professional | 51 · Multiple procedures | $27.54 | $29.51 | $31.62 |
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 Ohio. 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· 5th of 51
$77.62
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.