How much rates vary
Facilitymedian $955 · 10th to 90th $562 to $7,943Professionalmedian $708 · 10th to 90th $437 to $1,122
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 $549.54 Median $7,943.28 Typical High $17,378.01 | Facility | None | $549.54 | $7,943.28 | $17,378.01 |
Aetna Setting Professional Modifier None Typical Low $338.84 Median $446.68 Typical High $707.95 | Professional | None | $338.84 | $446.68 | $707.95 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $3,090.30 Typical High $4,168.69 | Facility | None | $1,000.00 | $3,090.30 | $4,168.69 |
Cigna Setting Professional Modifier None Typical Low $478.63 Median $724.44 Typical High $1,202.26 | Professional | None | $478.63 | $724.44 | $1,202.26 |
Kaiser Permanente Setting Professional Modifier None Typical Low $630.96 Median $851.14 Typical High $1,258.93 | Professional | None | $630.96 | $851.14 | $1,258.93 |
Moda Health Setting Facility Modifier None Typical Low $549.54 Median $1,174.90 Typical High $15,488.17 | Facility | None | $549.54 | $1,174.90 | $15,488.17 |
Moda Health Setting Professional Modifier None Typical Low $436.52 Median $676.08 Typical High $1,000.00 | Professional | None | $436.52 | $676.08 | $1,000.00 |
Pacific Source Setting Facility Modifier None Typical Low $562.34 Median $912.01 Typical High $977.24 | Facility | None | $562.34 | $912.01 | $977.24 |
Providence Setting Facility Modifier None Typical Low $660.69 Median $2,511.89 Typical High $4,168.69 | Facility | None | $660.69 | $2,511.89 | $4,168.69 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $724.44 Typical High $1,202.26 | Professional | None | $79.43 | $724.44 | $1,202.26 |
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 $616.60 Median $912.01 Typical High $977.24 | Professional | None | $616.60 | $912.01 | $977.24 |
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 $467.74 Median $758.58 Typical High $1,258.93 | Professional | None | $467.74 | $758.58 | $1,258.93 |
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 $223.87 Median $223.87 Typical High $354.81 | Professional | 52 · Reduced service | $223.87 | $223.87 | $354.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $89.13 Median $89.13 Typical High $141.25 | Professional | 53 · Discontinued | $89.13 | $89.13 | $141.25 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $338.84 Median $338.84 Typical High $537.03 | Professional | 54 · Surgery only | $338.84 | $338.84 | $537.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $67.61 Typical High $107.15 | Professional | 55 · Aftercare only | $67.61 | $67.61 | $107.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $44.67 Median $44.67 Typical High $70.79 | Professional | 56 · Pre-op care only | $44.67 | $44.67 | $70.79 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $316.23 Median $316.23 Typical High $501.19 | Professional | 78 · Unplanned return to OR | $316.23 | $316.23 | $501.19 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $223.87 Median $223.87 Typical High $354.81 | Professional | 52 · Reduced service | $223.87 | $223.87 | $354.81 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $89.13 Median $89.13 Typical High $141.25 | Professional | 53 · Discontinued | $89.13 | $89.13 | $141.25 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $338.84 Median $338.84 Typical High $537.03 | Professional | 54 · Surgery only | $338.84 | $338.84 | $537.03 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $67.61 Typical High $107.15 | Professional | 55 · Aftercare only | $67.61 | $67.61 | $107.15 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $44.67 Median $44.67 Typical High $70.79 | Professional | 56 · Pre-op care only | $44.67 | $44.67 | $70.79 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $316.23 Median $316.23 Typical High $501.19 | Professional | 78 · Unplanned return to OR | $316.23 | $316.23 | $501.19 |
Where Oregon sits
The same service costs 11.0 times more in Vermont than in Montana. 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 $12,892MT $1,170
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.