How much rates vary
Facilitymedian $661 · 10th to 90th $468 to $9,550Professionalmedian $603 · 10th to 90th $324 to $955
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 $588.84 Median $8,317.64 Typical High $17,378.01 | Facility | None | $588.84 | $8,317.64 | $17,378.01 |
Aetna Setting Professional Modifier None Typical Low $323.59 Median $478.63 Typical High $512.86 | Professional | None | $323.59 | $478.63 | $512.86 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $3,235.94 Typical High $4,466.84 | Facility | None | $1,000.00 | $3,235.94 | $4,466.84 |
Cigna Setting Professional Modifier None Typical Low $467.74 Median $616.60 Typical High $933.25 | Professional | None | $467.74 | $616.60 | $933.25 |
Kaiser Permanente Setting Professional Modifier None Typical Low $588.84 Median $676.08 Typical High $831.76 | Professional | None | $588.84 | $676.08 | $831.76 |
Moda Health Setting Facility Modifier None Typical Low $588.84 Median $3,981.07 Typical High $13,182.57 | Facility | None | $588.84 | $3,981.07 | $13,182.57 |
Moda Health Setting Professional Modifier None Typical Low $323.59 Median $478.63 Typical High $912.01 | Professional | None | $323.59 | $478.63 | $912.01 |
Pacific Source Setting Facility Modifier None Typical Low $389.05 Median $645.65 Typical High $691.83 | Facility | None | $389.05 | $645.65 | $691.83 |
Providence Setting Facility Modifier None Typical Low $660.69 Median $2,951.21 Typical High $4,466.84 | Facility | None | $660.69 | $2,951.21 | $4,466.84 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $630.96 Typical High $1,000.00 | Professional | None | $79.43 | $630.96 | $1,000.00 |
Regence BlueShield Setting Facility Modifier None Typical Low $9,332.54 Median $12,302.69 Typical High $15,135.61 | Facility | None | $9,332.54 | $12,302.69 | $15,135.61 |
Regence BlueShield Setting Professional Modifier None Typical Low $645.65 Median $691.83 Typical High $1,023.29 | Professional | None | $645.65 | $691.83 | $1,023.29 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,630.27 Typical High $25,118.86 | Facility | None | $1,513.56 | $2,630.27 | $25,118.86 |
United Setting Professional Modifier None Typical Low $501.19 Median $707.95 Typical High $1,174.90 | Professional | None | $501.19 | $707.95 | $1,174.90 |
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 $239.88 Typical High $239.88 | Professional | 52 · Reduced service | $223.87 | $239.88 | $239.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $91.20 Median $95.50 Typical High $95.50 | Professional | 53 · Discontinued | $91.20 | $95.50 | $95.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $338.84 Median $363.08 Typical High $363.08 | Professional | 54 · Surgery only | $338.84 | $363.08 | $363.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $72.44 Typical High $72.44 | Professional | 55 · Aftercare only | $67.61 | $72.44 | $72.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $44.67 Median $47.86 Typical High $47.86 | Professional | 56 · Pre-op care only | $44.67 | $47.86 | $47.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $316.23 Median $338.84 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $316.23 | $338.84 | $338.84 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | 52 · Reduced service | $239.88 | $239.88 | $239.88 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $95.50 Median $95.50 Typical High $95.50 | Professional | 53 · Discontinued | $95.50 | $95.50 | $95.50 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $363.08 Median $363.08 Typical High $363.08 | Professional | 54 · Surgery only | $363.08 | $363.08 | $363.08 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $72.44 Median $72.44 Typical High $72.44 | Professional | 55 · Aftercare only | $72.44 | $72.44 | $72.44 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $47.86 Median $47.86 Typical High $47.86 | Professional | 56 · Pre-op care only | $47.86 | $47.86 | $47.86 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $338.84 Median $338.84 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $338.84 | $338.84 | $338.84 |
Where Oregon sits
The same service costs 7.8 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 $8,433MT $1,087
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.