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 $46.77 Median $46.77 Typical High $46.77 | Facility | None | $46.77 | $46.77 | $46.77 |
Aetna Setting Professional Modifier None Typical Low $43.65 Median $46.77 Typical High $46.77 | Professional | None | $43.65 | $46.77 | $46.77 |
BCBS North Carolina Setting Facility Modifier None Typical Low $43.65 Median $43.65 Typical High $52.48 | Facility | None | $43.65 | $43.65 | $52.48 |
BCBS North Carolina Setting Professional Modifier None Typical Low $42.66 Median $54.95 Typical High $54.95 | Professional | None | $42.66 | $54.95 | $54.95 |
Cigna Setting Professional Modifier None Typical Low $26.30 Median $26.30 Typical High $39.81 | Professional | None | $26.30 | $26.30 | $39.81 |
Medcost Setting Facility Modifier None Typical Low $46.77 Median $46.77 Typical High $64.57 | Facility | None | $46.77 | $46.77 | $64.57 |
Medcost Setting Professional Modifier None Typical Low $35.48 Median $38.02 Typical High $39.81 | Professional | None | $35.48 | $38.02 | $39.81 |
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 $20.42 Typical High $31.62 | Professional | None | $12.88 | $20.42 | $31.62 |
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 $21.38 Median $23.44 Typical High $23.44 | Professional | 52 · Reduced service | $21.38 | $23.44 | $23.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.71 Median $9.33 Typical High $9.33 | Professional | 53 · Discontinued | $8.71 | $9.33 | $9.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.46 Median $7.08 Typical High $7.08 | Professional | 55 · Aftercare only | $6.46 | $7.08 | $7.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.37 Median $4.68 Typical High $4.68 | Professional | 56 · Pre-op care only | $4.37 | $4.68 | $4.68 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $17.78 Median $19.05 Typical High $19.95 | Professional | 51 · Multiple procedures | $17.78 | $19.05 | $19.95 |
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 3.9 times more in Montana than in Alaska. 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· 6th of 51
$50.12
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.