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 $74.13 Median $74.13 Typical High $74.13 | Facility | None | $74.13 | $74.13 | $74.13 |
Aetna Setting Professional Modifier None Typical Low $58.88 Median $74.13 Typical High $74.13 | Professional | None | $58.88 | $74.13 | $74.13 |
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 $61.66 | Professional | None | $38.02 | $38.02 | $61.66 |
Medcost Setting Facility Modifier None Typical Low $74.13 Median $74.13 Typical High $102.33 | Facility | None | $74.13 | $74.13 | $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 $50.12 Median $50.12 Typical High $64.57 | Professional | None | $50.12 | $50.12 | $64.57 |
United Setting Professional Modifier None Typical Low $15.14 Median $32.36 Typical High $43.65 | Professional | None | $15.14 | $32.36 | $43.65 |
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 $29.51 Median $37.15 Typical High $37.15 | Professional | 52 · Reduced service | $29.51 | $37.15 | $37.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $14.79 Typical High $14.79 | Professional | 53 · Discontinued | $12.02 | $14.79 | $14.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.91 Median $10.96 Typical High $10.96 | Professional | 55 · Aftercare only | $8.91 | $10.96 | $10.96 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.89 Median $7.41 Typical High $7.41 | Professional | 56 · Pre-op care only | $5.89 | $7.41 | $7.41 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $28.18 Median $29.51 Typical High $31.62 | Professional | 51 · Multiple procedures | $28.18 | $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 2.7 times more in Hawaii than in Utah. 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
$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.