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 $4.17 Median $4.17 Typical High $4.17 | Professional | None | $4.17 | $4.17 | $4.17 |
Cigna Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
Kaiser Permanente Setting Professional Modifier None Typical Low $9.33 Median $11.22 Typical High $151.36 | Professional | None | $9.33 | $11.22 | $151.36 |
Moda Health Setting Facility Modifier None Typical Low $4.17 Median $5.50 Typical High $6.03 | Facility | None | $4.17 | $5.50 | $6.03 |
Moda Health Setting Professional Modifier None Typical Low $4.17 Median $5.37 Typical High $5.75 | Professional | None | $4.17 | $5.37 | $5.75 |
Pacific Source Setting Facility Modifier None Typical Low $5.13 Median $5.62 Typical High $5.75 | Facility | None | $5.13 | $5.62 | $5.75 |
Providence Setting Facility Modifier None Typical Low $4.90 Median $5.01 Typical High $6.92 | Facility | None | $4.90 | $5.01 | $6.92 |
Providence Setting Professional Modifier None Typical Low $2.34 Median $4.68 Typical High $79.43 | Professional | None | $2.34 | $4.68 | $79.43 |
Regence BlueShield Setting Professional Modifier None Typical Low $6.03 Median $6.31 Typical High $6.31 | Professional | None | $6.03 | $6.31 | $6.31 |
United Setting Professional Modifier None Typical Low $1.91 Median $2.40 Typical High $4.68 | Professional | None | $1.91 | $2.40 | $4.68 |
10 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 $2.09 Median $2.09 Typical High $2.09 | Professional | 52 · Reduced service | $2.09 | $2.09 | $2.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.83 Median $0.83 Typical High $0.83 | Professional | 53 · Discontinued | $0.83 | $0.83 | $0.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.16 Median $3.16 Typical High $3.16 | Professional | 54 · Surgery only | $3.16 | $3.16 | $3.16 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.63 Median $0.63 Typical High $0.63 | Professional | 55 · Aftercare only | $0.63 | $0.63 | $0.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.42 Median $0.42 Typical High $0.42 | Professional | 56 · Pre-op care only | $0.42 | $0.42 | $0.42 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $2.09 Median $2.09 Typical High $2.09 | Professional | 52 · Reduced service | $2.09 | $2.09 | $2.09 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.83 Median $0.83 Typical High $0.83 | Professional | 53 · Discontinued | $0.83 | $0.83 | $0.83 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $3.16 Median $3.16 Typical High $3.16 | Professional | 54 · Surgery only | $3.16 | $3.16 | $3.16 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.63 Median $0.63 Typical High $0.63 | Professional | 55 · Aftercare only | $0.63 | $0.63 | $0.63 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.42 Median $0.42 Typical High $0.42 | Professional | 56 · Pre-op care only | $0.42 | $0.42 | $0.42 |
Where Oregon sits
The same service costs 3.0 times more in Rhode Island than in New York. 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· 23rd of 51
$4.17
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.