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 Professional Modifier None Typical Low $33.88 Median $36.31 Typical High $36.31 | Professional | None | $33.88 | $36.31 | $36.31 |
Medica Setting Facility Modifier None Typical Low $60.26 Median $109.65 Typical High $109.65 | Facility | None | $60.26 | $109.65 | $109.65 |
Oscar Health Setting Professional Modifier None Typical Low $128.82 Median $144.54 Typical High $173.78 | Professional | None | $128.82 | $144.54 | $173.78 |
United Setting Professional Modifier None Typical Low $12.02 Median $12.88 Typical High $34.67 | Professional | None | $12.02 | $12.88 | $34.67 |
Wellmark Setting Professional Modifier None Typical Low $79.43 Median $79.43 Typical High $79.43 | Professional | None | $79.43 | $79.43 | $79.43 |
7 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 $16.98 Median $18.20 Typical High $18.20 | Professional | 52 · Reduced service | $16.98 | $18.20 | $18.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.76 Median $7.24 Typical High $7.24 | Professional | 53 · Discontinued | $6.76 | $7.24 | $7.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.01 Median $5.37 Typical High $5.37 | Professional | 55 · Aftercare only | $5.01 | $5.37 | $5.37 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.39 Median $3.63 Typical High $3.63 | Professional | 56 · Pre-op care only | $3.39 | $3.63 | $3.63 |
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 Iowa sits
The same service costs 7.8 times more in Montana than in Nebraska. 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.
Iowa· 3rd of 51
$79.43
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.