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 $21.88 Median $21.88 Typical High $25.12 | Facility | None | $21.88 | $21.88 | $25.12 |
Aetna Setting Professional Modifier None Typical Low $21.88 Median $21.88 Typical High $50.12 | Professional | None | $21.88 | $21.88 | $50.12 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $10.96 Median $10.96 Typical High $23.99 | Professional | 52 · Reduced service | $10.96 | $10.96 | $23.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.37 Median $4.37 Typical High $9.33 | Professional | 53 · Discontinued | $4.37 | $4.37 | $9.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.24 Median $3.24 Typical High $7.08 | Professional | 55 · Aftercare only | $3.24 | $3.24 | $7.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.19 Median $2.19 Typical High $4.68 | Professional | 56 · Pre-op care only | $2.19 | $2.19 | $4.68 |
Cigna Setting Professional Modifier None Typical Low $33.88 Median $33.88 Typical High $33.88 | Professional | None | $33.88 | $33.88 | $33.88 |
Emblem Health Setting Professional Modifier None Typical Low $81.28 Median $102.33 Typical High $102.33 | Professional | None | $81.28 | $102.33 | $102.33 |
Horizon BCBS Setting Professional Modifier None Typical Low $48.98 Median $48.98 Typical High $50.12 | Professional | None | $48.98 | $48.98 | $50.12 |
United Setting Facility Modifier None Typical Low $79.43 Median $79.43 Typical High $95.50 | Facility | None | $79.43 | $79.43 | $95.50 |
United Setting Professional Modifier None Typical Low $19.05 Median $40.74 Typical High $46.77 | Professional | None | $19.05 | $40.74 | $46.77 |
3 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 $25.12 Median $25.12 Typical High $54.95 | Professional | MV | $25.12 | $25.12 | $54.95 |
AmeriHealth Setting Professional Modifier PL · Progressive lenses Typical Low $25.12 Median $25.12 Typical High $54.95 | Professional | PL · Progressive lenses | $25.12 | $25.12 | $54.95 |
AmeriHealth Setting Professional Modifier SV · Delivered, not used Typical Low $25.12 Median $25.12 Typical High $54.95 | Professional | SV · Delivered, not used | $25.12 | $25.12 | $54.95 |
Where New Jersey sits
The same service costs 3.2 times more in Montana 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.
New Jersey· 38th of 51
$40.74
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.