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 $151.36 Median $151.36 Typical High $151.36 | Facility | None | $151.36 | $151.36 | $151.36 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $151.36 Typical High $151.36 | Professional | None | $104.71 | $151.36 | $151.36 |
BCBS North Carolina Setting Facility Modifier None Typical Low $141.25 Median $141.25 Typical High $169.82 | Facility | None | $141.25 | $141.25 | $169.82 |
BCBS North Carolina Setting Professional Modifier None Typical Low $138.04 Median $173.78 Typical High $173.78 | Professional | None | $138.04 | $173.78 | $173.78 |
Cigna Setting Professional Modifier None Typical Low $63.10 Median $63.10 Typical High $125.89 | Professional | None | $63.10 | $63.10 | $125.89 |
Medcost Setting Facility Modifier None Typical Low $151.36 Median $151.36 Typical High $208.93 | Facility | None | $151.36 | $151.36 | $208.93 |
Medcost Setting Professional Modifier None Typical Low $114.82 Median $120.23 Typical High $128.82 | Professional | None | $114.82 | $120.23 | $128.82 |
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 $44.67 Typical High $87.10 | Professional | None | $15.14 | $44.67 | $87.10 |
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 $52.48 Median $75.86 Typical High $75.86 | Professional | 52 · Reduced service | $52.48 | $75.86 | $75.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $30.20 Typical High $30.20 | Professional | 53 · Discontinued | $21.38 | $30.20 | $30.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $22.39 Typical High $22.39 | Professional | 55 · Aftercare only | $15.85 | $22.39 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $15.14 Typical High $15.14 | Professional | 56 · Pre-op care only | $10.47 | $15.14 | $15.14 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $57.54 Median $60.26 Typical High $64.57 | Professional | 51 · Multiple procedures | $57.54 | $60.26 | $64.57 |
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 2.9 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· 2nd of 51
$158
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.