How much rates vary
Facilitymedian $407 · 10th to 90th $162 to $5,012Professionalmedian $162 · 10th to 90th $89 to $229
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $177.83 Median $199.53 Typical High $199.53 | Facility | None | $177.83 | $199.53 | $199.53 |
Aetna Setting Professional Modifier None Typical Low $147.91 Median $177.83 Typical High $199.53 | Professional | None | $147.91 | $177.83 | $199.53 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $74.13 Median $89.13 Typical High $100.00 | Professional | 52 · Reduced service | $74.13 | $89.13 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $29.51 Median $35.48 Typical High $39.81 | Professional | 53 · Discontinued | $29.51 | $35.48 | $39.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $26.30 Typical High $29.51 | Professional | 55 · Aftercare only | $22.39 | $26.30 | $29.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.79 Median $17.78 Typical High $19.95 | Professional | 56 · Pre-op care only | $14.79 | $17.78 | $19.95 |
Capital Blue Cross Setting Facility Modifier None Typical Low $4,265.80 Median $5,011.87 Typical High $79,432.82 | Facility | None | $4,265.80 | $5,011.87 | $79,432.82 |
Capital Blue Cross Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $229.09 | Professional | None | $229.09 | $229.09 | $229.09 |
Cigna Setting Professional Modifier None Typical Low $89.13 Median $89.13 Typical High $89.13 | Professional | None | $89.13 | $89.13 | $89.13 |
Emblem Health Setting Professional Modifier None Typical Low $251.19 Median $331.13 Typical High $426.58 | Professional | None | $251.19 | $331.13 | $426.58 |
Geisinger Setting Facility Modifier None Typical Low $229.09 Median $229.09 Typical High $229.09 | Facility | None | $229.09 | $229.09 | $229.09 |
Geisinger Setting Professional Modifier None Typical Low $138.04 Median $177.83 Typical High $229.09 | Professional | None | $138.04 | $177.83 | $229.09 |
Martin's Point Setting Facility Modifier None Typical Low $199.53 Median $199.53 Typical High $199.53 | Facility | None | $199.53 | $199.53 | $199.53 |
Martin's Point Setting Professional Modifier None Typical Low $162.18 Median $177.83 Typical High $199.53 | Professional | None | $162.18 | $177.83 | $199.53 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $81.28 Median $89.13 Typical High $100.00 | Professional | 52 · Reduced service | $81.28 | $89.13 | $100.00 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $35.48 Typical High $39.81 | Professional | 53 · Discontinued | $32.36 | $35.48 | $39.81 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $26.30 Typical High $29.51 | Professional | 55 · Aftercare only | $23.99 | $26.30 | $29.51 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $17.78 Typical High $19.95 | Professional | 56 · Pre-op care only | $16.22 | $17.78 | $19.95 |
Oscar Health Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $323.59 | Professional | None | $323.59 | $323.59 | $323.59 |
UPMC Health Plan Setting Facility Modifier None Typical Low $162.18 Median $741.31 Typical High $1,258.93 | Facility | None | $162.18 | $741.31 | $1,258.93 |
UPMC Health Plan Setting Professional Modifier None Typical Low $158.49 Median $162.18 Typical High $213.80 | Professional | None | $158.49 | $162.18 | $213.80 |
United Setting Facility Modifier None Typical Low $245.47 Median $245.47 Typical High $295.12 | Facility | None | $245.47 | $245.47 | $295.12 |
United Setting Professional Modifier None Typical Low $102.33 Median $112.20 Typical High $123.03 | Professional | None | $102.33 | $112.20 | $123.03 |
6 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 |
|---|---|---|---|---|---|
AmeriHealth Setting Professional Modifier PL · Progressive lenses Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | PL · Progressive lenses | $60.26 | $60.26 | $60.26 |
Independence Blue Cross Setting Professional Modifier PL · Progressive lenses Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | PL · Progressive lenses | $60.26 | $60.26 | $60.26 |
Oscar Health Setting Professional Modifier PL · Progressive lenses Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | PL · Progressive lenses | $60.26 | $60.26 | $60.26 |
United Setting Professional Modifier CD · Dialysis lab test, bundled Typical Low $50.12 Median $50.12 Typical High $50.12 | Professional | CD · Dialysis lab test, bundled | $50.12 | $50.12 | $50.12 |
United Setting Professional Modifier CM · 80–99% impaired Typical Low $70.79 Median $70.79 Typical High $70.79 | Professional | CM · 80–99% impaired | $70.79 | $70.79 | $70.79 |
United Setting Professional Modifier XC Typical Low $1,513.56 Median $1,513.56 Typical High $1,513.56 | Professional | XC | $1,513.56 | $1,513.56 | $1,513.56 |
Where Pennsylvania sits
The same service costs 2.6 times more in Minnesota 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.
Pennsylvania· 11th of 51
$162
MN $229UT $89.13
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.