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 $100.00 Median $100.00 Typical High $100.00 | Facility | None | $100.00 | $100.00 | $100.00 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $100.00 Typical High $100.00 | Professional | None | $85.11 | $100.00 | $100.00 |
BCBS North Carolina Setting Facility Modifier None Typical Low $95.50 Median $95.50 Typical High $114.82 | Facility | None | $95.50 | $95.50 | $114.82 |
BCBS North Carolina Setting Professional Modifier None Typical Low $93.33 Median $117.49 Typical High $117.49 | Professional | None | $93.33 | $117.49 | $117.49 |
Cigna Setting Professional Modifier None Typical Low $52.48 Median $52.48 Typical High $85.11 | Professional | None | $52.48 | $52.48 | $85.11 |
Medcost Setting Facility Modifier None Typical Low $100.00 Median $100.00 Typical High $138.04 | Facility | None | $100.00 | $100.00 | $138.04 |
Medcost Setting Professional Modifier None Typical Low $75.86 Median $81.28 Typical High $87.10 | Professional | None | $75.86 | $81.28 | $87.10 |
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 $38.02 Typical High $57.54 | Professional | None | $15.14 | $38.02 | $57.54 |
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 $50.12 Typical High $50.12 | Professional | 52 · Reduced service | $42.66 | $50.12 | $50.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $19.95 Typical High $19.95 | Professional | 53 · Discontinued | $16.98 | $19.95 | $19.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $15.14 Typical High $15.14 | Professional | 55 · Aftercare only | $12.88 | $15.14 | $15.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $10.00 Typical High $10.00 | Professional | 56 · Pre-op care only | $8.51 | $10.00 | $10.00 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $38.02 Median $40.74 Typical High $43.65 | Professional | 51 · Multiple procedures | $38.02 | $40.74 | $43.65 |
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 4.2 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· 6th of 51
$107
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.