How much rates vary
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 Professional Modifier None Typical Low $3.39 Median $3.72 Typical High $3.72 | Professional | None | $3.39 | $3.72 | $3.72 |
Cigna Setting Facility Modifier None Typical Low $3.55 Median $3.55 Typical High $3.55 | Facility | None | $3.55 | $3.55 | $3.55 |
Cigna Setting Professional Modifier None Typical Low $2.95 Median $2.95 Typical High $3.55 | Professional | None | $2.95 | $2.95 | $3.55 |
Kaiser Permanente Setting Professional Modifier None Typical Low $4.68 Median $13.18 Typical High $16.60 | Professional | None | $4.68 | $13.18 | $16.60 |
Moda Health Setting Facility Modifier None Typical Low $3.72 Median $5.37 Typical High $6.31 | Facility | None | $3.72 | $5.37 | $6.31 |
Moda Health Setting Professional Modifier None Typical Low $3.72 Median $5.62 Typical High $6.31 | Professional | None | $3.72 | $5.62 | $6.31 |
Pacific Source Setting Facility Modifier None Typical Low $6.03 Median $6.17 Typical High $6.31 | Facility | None | $6.03 | $6.17 | $6.31 |
Providence Setting Facility Modifier None Typical Low $3.55 Median $3.72 Typical High $6.31 | Facility | None | $3.55 | $3.72 | $6.31 |
Providence Setting Professional Modifier None Typical Low $2.95 Median $5.25 Typical High $79.43 | Professional | None | $2.95 | $5.25 | $79.43 |
Regence BlueShield Setting Facility Modifier None Typical Low $4.90 Median $9.77 Typical High $23.99 | Facility | None | $4.90 | $9.77 | $23.99 |
Regence BlueShield Setting Professional Modifier None Typical Low $6.31 Median $6.92 Typical High $6.92 | Professional | None | $6.31 | $6.92 | $6.92 |
United Setting Facility Modifier None Typical Low $9.12 Median $9.12 Typical High $12.30 | Facility | None | $9.12 | $9.12 | $12.30 |
United Setting Professional Modifier None Typical Low $2.57 Median $2.82 Typical High $5.50 | Professional | None | $2.57 | $2.82 | $5.50 |
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 |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $1.70 Median $1.86 Typical High $1.86 | Professional | 52 · Reduced service | $1.70 | $1.86 | $1.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.68 Median $0.74 Typical High $0.74 | Professional | 53 · Discontinued | $0.68 | $0.74 | $0.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.51 Median $0.56 Typical High $0.56 | Professional | 55 · Aftercare only | $0.51 | $0.56 | $0.56 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.34 Median $0.37 Typical High $0.37 | Professional | 56 · Pre-op care only | $0.34 | $0.37 | $0.37 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1.86 Median $1.86 Typical High $1.86 | Professional | 52 · Reduced service | $1.86 | $1.86 | $1.86 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.74 Median $0.74 Typical High $0.74 | Professional | 53 · Discontinued | $0.74 | $0.74 | $0.74 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.56 Median $0.56 Typical High $0.56 | Professional | 55 · Aftercare only | $0.56 | $0.56 | $0.56 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.37 Median $0.37 Typical High $0.37 | Professional | 56 · Pre-op care only | $0.37 | $0.37 | $0.37 |
Where Oregon sits
The same service costs 4.9 times more in Kansas than in Delaware. 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.
Oregon· 12th of 51
$5.37
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.