How much rates vary
Facilitymedian $79 · 10th to 90th $18 to $5,012Professionalmedian $17 · 10th to 90th $9 to $25
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 $19.05 Median $21.38 Typical High $21.38 | Facility | None | $19.05 | $21.38 | $21.38 |
Aetna Setting Professional Modifier None Typical Low $15.49 Median $19.05 Typical High $21.38 | Professional | None | $15.49 | $19.05 | $21.38 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $7.76 Median $9.55 Typical High $10.72 | Professional | 52 · Reduced service | $7.76 | $9.55 | $10.72 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.09 Median $3.80 Typical High $4.37 | Professional | 53 · Discontinued | $3.09 | $3.80 | $4.37 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.29 Median $2.88 Typical High $3.24 | Professional | 55 · Aftercare only | $2.29 | $2.88 | $3.24 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.55 Median $1.91 Typical High $2.14 | Professional | 56 · Pre-op care only | $1.55 | $1.91 | $2.14 |
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 $24.55 Median $24.55 Typical High $24.55 | Professional | None | $24.55 | $24.55 | $24.55 |
Cigna Setting Professional Modifier None Typical Low $9.33 Median $9.33 Typical High $9.33 | Professional | None | $9.33 | $9.33 | $9.33 |
Emblem Health Setting Professional Modifier None Typical Low $22.91 Median $30.20 Typical High $38.02 | Professional | None | $22.91 | $30.20 | $38.02 |
Geisinger Setting Facility Modifier None Typical Low $25.12 Median $25.12 Typical High $25.12 | Facility | None | $25.12 | $25.12 | $25.12 |
Geisinger Setting Professional Modifier None Typical Low $15.14 Median $17.78 Typical High $25.12 | Professional | None | $15.14 | $17.78 | $25.12 |
Martin's Point Setting Facility Modifier None Typical Low $21.38 Median $21.38 Typical High $21.38 | Facility | None | $21.38 | $21.38 | $21.38 |
Martin's Point Setting Professional Modifier None Typical Low $15.85 Median $19.05 Typical High $21.38 | Professional | None | $15.85 | $19.05 | $21.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $8.13 Median $9.55 Typical High $10.72 | Professional | 52 · Reduced service | $8.13 | $9.55 | $10.72 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $3.24 Median $3.80 Typical High $4.37 | Professional | 53 · Discontinued | $3.24 | $3.80 | $4.37 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.45 Median $2.88 Typical High $3.24 | Professional | 55 · Aftercare only | $2.45 | $2.88 | $3.24 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.62 Median $1.91 Typical High $2.14 | Professional | 56 · Pre-op care only | $1.62 | $1.91 | $2.14 |
Oscar Health Setting Professional Modifier None Typical Low $28.84 Median $28.84 Typical High $28.84 | Professional | None | $28.84 | $28.84 | $28.84 |
UPMC Health Plan Setting Facility Modifier None Typical Low $17.78 Median $79.43 Typical High $138.04 | Facility | None | $17.78 | $79.43 | $138.04 |
UPMC Health Plan Setting Professional Modifier None Typical Low $16.98 Median $17.78 Typical High $23.44 | Professional | None | $16.98 | $17.78 | $23.44 |
United Setting Professional Modifier None Typical Low $11.22 Median $12.30 Typical High $13.18 | Professional | None | $11.22 | $12.30 | $13.18 |
9 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 MV Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | MV | $10.00 | $10.00 | $10.00 |
AmeriHealth Setting Professional Modifier PL · Progressive lenses Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | PL · Progressive lenses | $10.00 | $10.00 | $10.00 |
AmeriHealth Setting Professional Modifier PM · Post mortem Typical Low $5.01 Median $5.01 Typical High $30.20 | Professional | PM · Post mortem | $5.01 | $5.01 | $30.20 |
AmeriHealth Setting Professional Modifier SV · Delivered, not used Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | SV · Delivered, not used | $10.00 | $10.00 | $10.00 |
Independence Blue Cross Setting Professional Modifier MV Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | MV | $10.00 | $10.00 | $10.00 |
Independence Blue Cross Setting Professional Modifier PL · Progressive lenses Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | PL · Progressive lenses | $10.00 | $10.00 | $10.00 |
Independence Blue Cross Setting Professional Modifier PM · Post mortem Typical Low $5.01 Median $5.01 Typical High $30.20 | Professional | PM · Post mortem | $5.01 | $5.01 | $30.20 |
Independence Blue Cross Setting Professional Modifier SV · Delivered, not used Typical Low $10.00 Median $10.00 Typical High $10.00 | Professional | SV · Delivered, not used | $10.00 | $10.00 | $10.00 |
Oscar Health Setting Professional Modifier PM · Post mortem Typical Low $5.01 Median $5.01 Typical High $30.20 | Professional | PM · Post mortem | $5.01 | $5.01 | $30.20 |
Where Pennsylvania 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.
Pennsylvania· 11th of 51
$17.38
HI $36.31NY $8.71
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.