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 $95.50 Median $95.50 Typical High $95.50 | Facility | None | $95.50 | $95.50 | $95.50 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $95.50 Typical High $95.50 | Professional | None | $85.11 | $95.50 | $95.50 |
BCBS North Carolina Setting Professional Modifier None Typical Low $89.13 Median $112.20 Typical High $112.20 | Professional | None | $89.13 | $112.20 | $112.20 |
Cigna Setting Professional Modifier None Typical Low $48.98 Median $48.98 Typical High $83.18 | Professional | None | $48.98 | $48.98 | $83.18 |
Medcost Setting Facility Modifier None Typical Low $95.50 Median $95.50 Typical High $131.83 | Facility | None | $95.50 | $95.50 | $131.83 |
Medcost Setting Professional Modifier None Typical Low $72.44 Median $77.62 Typical High $83.18 | Professional | None | $72.44 | $77.62 | $83.18 |
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 $34.67 Typical High $54.95 | Professional | None | $12.88 | $34.67 | $54.95 |
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 $42.66 Median $47.86 Typical High $47.86 | Professional | 52 · Reduced service | $42.66 | $47.86 | $47.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $19.05 Typical High $19.05 | Professional | 53 · Discontinued | $16.98 | $19.05 | $19.05 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $14.45 Typical High $14.45 | Professional | 55 · Aftercare only | $12.88 | $14.45 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $9.55 Typical High $9.55 | Professional | 56 · Pre-op care only | $8.51 | $9.55 | $9.55 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $36.31 Median $38.90 Typical High $40.74 | Professional | 51 · Multiple procedures | $36.31 | $38.90 | $40.74 |
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 Hawaii 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· 4th of 51
$102
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.