How much rates vary
Facilitymedian $1,445 · 10th to 90th $871 to $8,128Professionalmedian $1,318 · 10th to 90th $692 to $2,042
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 $5,128.61 Median $11,748.98 Typical High $24,547.09 | Facility | None | $5,128.61 | $11,748.98 | $24,547.09 |
Aetna Setting Professional Modifier None Typical Low $660.69 Median $1,047.13 Typical High $1,122.02 | Professional | None | $660.69 | $1,047.13 | $1,122.02 |
Cigna Setting Facility Modifier None Typical Low $1,412.54 Median $3,162.28 Typical High $4,168.69 | Facility | None | $1,412.54 | $3,162.28 | $4,168.69 |
Cigna Setting Professional Modifier None Typical Low $794.33 Median $1,258.93 Typical High $2,089.30 | Professional | None | $794.33 | $1,258.93 | $2,089.30 |
Kaiser Permanente Setting Professional Modifier None Typical Low $1,288.25 Median $1,513.56 Typical High $1,862.09 | Professional | None | $1,288.25 | $1,513.56 | $1,862.09 |
Moda Health Setting Facility Modifier None Typical Low $1,148.15 Median $2,041.74 Typical High $24,547.09 | Facility | None | $1,148.15 | $2,041.74 | $24,547.09 |
Moda Health Setting Professional Modifier None Typical Low $741.31 Median $1,047.13 Typical High $1,659.59 | Professional | None | $741.31 | $1,047.13 | $1,659.59 |
Pacific Source Setting Facility Modifier None Typical Low $851.14 Median $1,380.38 Typical High $1,513.56 | Facility | None | $851.14 | $1,380.38 | $1,513.56 |
Providence Setting Facility Modifier None Typical Low $1,174.90 Median $2,818.38 Typical High $4,168.69 | Facility | None | $1,174.90 | $2,818.38 | $4,168.69 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $1,348.96 Typical High $2,089.30 | Professional | None | $79.43 | $1,348.96 | $2,089.30 |
Regence BlueShield Setting Facility Modifier None Typical Low $8,128.31 Median $11,481.54 Typical High $12,882.50 | Facility | None | $8,128.31 | $11,481.54 | $12,882.50 |
Regence BlueShield Setting Professional Modifier None Typical Low $1,445.44 Median $1,513.56 Typical High $1,949.84 | Professional | None | $1,445.44 | $1,513.56 | $1,949.84 |
United Setting Facility Modifier None Typical Low $1,230.27 Median $1,862.09 Typical High $12,302.69 | Facility | None | $1,230.27 | $1,862.09 | $12,302.69 |
United Setting Professional Modifier None Typical Low $851.14 Median $1,318.26 Typical High $2,187.76 | Professional | None | $851.14 | $1,318.26 | $2,187.76 |
12 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 $426.58 Median $524.81 Typical High $524.81 | Professional | 52 · Reduced service | $426.58 | $524.81 | $524.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $208.93 Typical High $208.93 | Professional | 53 · Discontinued | $169.82 | $208.93 | $208.93 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $645.65 Median $794.33 Typical High $794.33 | Professional | 54 · Surgery only | $645.65 | $794.33 | $794.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $128.82 Median $158.49 Typical High $158.49 | Professional | 55 · Aftercare only | $128.82 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $104.71 Typical High $104.71 | Professional | 56 · Pre-op care only | $85.11 | $104.71 | $104.71 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $602.56 Median $741.31 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $602.56 | $741.31 | $741.31 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $524.81 Median $524.81 Typical High $524.81 | Professional | 52 · Reduced service | $524.81 | $524.81 | $524.81 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $208.93 Median $208.93 Typical High $208.93 | Professional | 53 · Discontinued | $208.93 | $208.93 | $208.93 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $794.33 Typical High $794.33 | Professional | 54 · Surgery only | $794.33 | $794.33 | $794.33 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $158.49 Typical High $158.49 | Professional | 55 · Aftercare only | $158.49 | $158.49 | $158.49 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $104.71 Median $104.71 Typical High $104.71 | Professional | 56 · Pre-op care only | $104.71 | $104.71 | $104.71 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $741.31 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $741.31 | $741.31 | $741.31 |
Where Oregon sits
The same service costs 5.9 times more in Vermont than in West Virginia. 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.
Physician feeFacility fee
VT $13,930WV $2,343
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.