How much rates vary
Facilitymedian $170 · 10th to 90th $66 to $5,012Professionalmedian $60 · 10th to 90th $38 to $85
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 $66.07 Median $74.13 Typical High $74.13 | Facility | None | $66.07 | $74.13 | $74.13 |
Aetna Setting Professional Modifier None Typical Low $60.26 Median $66.07 Typical High $74.13 | Professional | None | $60.26 | $66.07 | $74.13 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $30.20 Median $33.11 Typical High $37.15 | Professional | 52 · Reduced service | $30.20 | $33.11 | $37.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $13.18 Typical High $15.14 | Professional | 53 · Discontinued | $12.02 | $13.18 | $15.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.12 Median $10.00 Typical High $11.22 | Professional | 55 · Aftercare only | $9.12 | $10.00 | $11.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.03 Median $6.61 Typical High $7.41 | Professional | 56 · Pre-op care only | $6.03 | $6.61 | $7.41 |
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 $85.11 Median $85.11 Typical High $85.11 | Professional | None | $85.11 | $85.11 | $85.11 |
Cigna Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | None | $38.02 | $38.02 | $38.02 |
Emblem Health Setting Professional Modifier None Typical Low $95.50 Median $125.89 Typical High $162.18 | Professional | None | $95.50 | $125.89 | $162.18 |
Geisinger Setting Facility Modifier None Typical Low $87.10 Median $87.10 Typical High $87.10 | Facility | None | $87.10 | $87.10 | $87.10 |
Geisinger Setting Professional Modifier None Typical Low $52.48 Median $61.66 Typical High $87.10 | Professional | None | $52.48 | $61.66 | $87.10 |
Martin's Point Setting Facility Modifier None Typical Low $74.13 Median $74.13 Typical High $74.13 | Facility | None | $74.13 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier None Typical Low $60.26 Median $66.07 Typical High $74.13 | Professional | None | $60.26 | $66.07 | $74.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $30.20 Median $33.11 Typical High $37.15 | Professional | 52 · Reduced service | $30.20 | $33.11 | $37.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $13.18 Typical High $15.14 | Professional | 53 · Discontinued | $12.02 | $13.18 | $15.14 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $9.12 Median $10.00 Typical High $11.22 | Professional | 55 · Aftercare only | $9.12 | $10.00 | $11.22 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.03 Median $6.61 Typical High $7.41 | Professional | 56 · Pre-op care only | $6.03 | $6.61 | $7.41 |
Oscar Health Setting Professional Modifier None Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | None | $123.03 | $123.03 | $123.03 |
UPMC Health Plan Setting Facility Modifier None Typical Low $61.66 Median $275.42 Typical High $478.63 | Facility | None | $61.66 | $275.42 | $478.63 |
UPMC Health Plan Setting Professional Modifier None Typical Low $61.66 Median $61.66 Typical High $81.28 | Professional | None | $61.66 | $61.66 | $81.28 |
United Setting Facility Modifier None Typical Low $107.15 Median $107.15 Typical High $128.82 | Facility | None | $107.15 | $107.15 | $128.82 |
United Setting Professional Modifier None Typical Low $19.05 Median $42.66 Typical High $45.71 | Professional | None | $19.05 | $42.66 | $45.71 |
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 |
|---|---|---|---|---|---|
AmeriHealth Setting Professional Modifier MV Typical Low $39.81 Median $39.81 Typical High $120.23 | Professional | MV | $39.81 | $39.81 | $120.23 |
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 $39.81 Median $39.81 Typical High $120.23 | Professional | SV · Delivered, not used | $39.81 | $39.81 | $120.23 |
Independence Blue Cross Setting Professional Modifier MV Typical Low $39.81 Median $39.81 Typical High $120.23 | Professional | MV | $39.81 | $39.81 | $120.23 |
Independence Blue Cross 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 |
Independence Blue Cross Setting Professional Modifier SV · Delivered, not used Typical Low $39.81 Median $39.81 Typical High $120.23 | Professional | SV · Delivered, not used | $39.81 | $39.81 | $120.23 |
Oscar Health Setting Professional Modifier MV Typical Low $39.81 Median $39.81 Typical High $120.23 | Professional | MV | $39.81 | $39.81 | $120.23 |
Oscar Health Setting Professional Modifier SV · Delivered, not used Typical Low $39.81 Median $39.81 Typical High $120.23 | Professional | SV · Delivered, not used | $39.81 | $39.81 | $120.23 |
Where Pennsylvania sits
The same service costs 2.8 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.
Pennsylvania· 22nd of 51
$61.66
MT $100NY $35.48
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.