How much rates vary
Facilitymedian $5,129 · 10th to 90th $1,122 to $7,943Professionalmedian $5,129 · 10th to 90th $2,512 to $7,762
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 $7,943.28 Typical High $19,952.62 | Facility | None | $5,128.61 | $7,943.28 | $19,952.62 |
Aetna Setting Professional Modifier None Typical Low $2,511.89 Median $3,890.45 Typical High $3,890.45 | Professional | None | $2,511.89 | $3,890.45 | $3,890.45 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $1,000.00 Typical High $23,988.33 | Facility | None | $549.54 | $1,000.00 | $23,988.33 |
Cigna Setting Professional Modifier None Typical Low $3,630.78 Median $4,786.30 Typical High $7,585.78 | Professional | None | $3,630.78 | $4,786.30 | $7,585.78 |
Kaiser Permanente Setting Professional Modifier None Typical Low $4,466.84 Median $5,128.61 Typical High $6,165.95 | Professional | None | $4,466.84 | $5,128.61 | $6,165.95 |
Moda Health Setting Facility Modifier None Typical Low $3,890.45 Median $6,309.57 Typical High $7,943.28 | Facility | None | $3,890.45 | $6,309.57 | $7,943.28 |
Moda Health Setting Professional Modifier None Typical Low $3,801.89 Median $3,890.45 Typical High $7,079.46 | Professional | None | $3,801.89 | $3,890.45 | $7,079.46 |
Pacific Source Setting Facility Modifier None Typical Low $3,090.30 Median $5,128.61 Typical High $5,495.41 | Facility | None | $3,090.30 | $5,128.61 | $5,495.41 |
Providence Setting Facility Modifier None Typical Low $1,023.29 Median $251,188.64 Typical High $251,188.64 | Facility | None | $1,023.29 | $251,188.64 | $251,188.64 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $5,011.87 Typical High $7,943.28 | Professional | None | $79.43 | $5,011.87 | $7,943.28 |
Regence BlueShield Setting Facility Modifier None Typical Low $13,803.84 Median $13,803.84 Typical High $13,803.84 | Facility | None | $13,803.84 | $13,803.84 | $13,803.84 |
Regence BlueShield Setting Professional Modifier None Typical Low $5,248.07 Median $5,495.41 Typical High $8,128.31 | Professional | None | $5,248.07 | $5,495.41 | $8,128.31 |
United Setting Facility Modifier None Typical Low $602.56 Median $870.96 Typical High $11,481.54 | Facility | None | $602.56 | $870.96 | $11,481.54 |
United Setting Professional Modifier None Typical Low $3,890.45 Median $5,623.41 Typical High $9,332.54 | Professional | None | $3,890.45 | $5,623.41 | $9,332.54 |
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 $1,905.46 Median $1,949.84 Typical High $1,949.84 | Professional | 52 · Reduced service | $1,905.46 | $1,949.84 | $1,949.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $758.58 Median $776.25 Typical High $776.25 | Professional | 53 · Discontinued | $758.58 | $776.25 | $776.25 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,884.03 Median $2,951.21 Typical High $2,951.21 | Professional | 54 · Surgery only | $2,884.03 | $2,951.21 | $2,951.21 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $575.44 Median $588.84 Typical High $588.84 | Professional | 55 · Aftercare only | $575.44 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $380.19 Median $389.05 Typical High $389.05 | Professional | 56 · Pre-op care only | $380.19 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,691.53 Median $2,754.23 Typical High $2,754.23 | Professional | 78 · Unplanned return to OR | $2,691.53 | $2,754.23 | $2,754.23 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1,949.84 Median $1,949.84 Typical High $1,949.84 | Professional | 52 · Reduced service | $1,949.84 | $1,949.84 | $1,949.84 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $776.25 Median $776.25 Typical High $776.25 | Professional | 53 · Discontinued | $776.25 | $776.25 | $776.25 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $2,951.21 Median $2,951.21 Typical High $2,951.21 | Professional | 54 · Surgery only | $2,951.21 | $2,951.21 | $2,951.21 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $588.84 Median $588.84 Typical High $588.84 | Professional | 55 · Aftercare only | $588.84 | $588.84 | $588.84 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $389.05 Median $389.05 Typical High $389.05 | Professional | 56 · Pre-op care only | $389.05 | $389.05 | $389.05 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,754.23 Median $2,754.23 Typical High $2,754.23 | Professional | 78 · Unplanned return to OR | $2,754.23 | $2,754.23 | $2,754.23 |
Where Oregon sits
The same service costs 12.3 times more in Maine than in Washington. 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
ME $36,075WA $2,929
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.