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 $34.67 Median $38.02 Typical High $39.81 | Professional | None | $34.67 | $38.02 | $39.81 |
Cigna Setting Professional Modifier None Typical Low $21.38 Median $21.38 Typical High $21.38 | Professional | None | $21.38 | $21.38 | $21.38 |
Kaiser Permanente Setting Professional Modifier None Typical Low $85.11 Median $100.00 Typical High $151.36 | Professional | None | $85.11 | $100.00 | $151.36 |
Moda Health Setting Facility Modifier None Typical Low $38.02 Median $50.12 Typical High $53.70 | Facility | None | $38.02 | $50.12 | $53.70 |
Moda Health Setting Professional Modifier None Typical Low $38.02 Median $50.12 Typical High $67.61 | Professional | None | $38.02 | $50.12 | $67.61 |
Pacific Source Setting Facility Modifier None Typical Low $46.77 Median $50.12 Typical High $51.29 | Facility | None | $46.77 | $50.12 | $51.29 |
Providence Setting Facility Modifier None Typical Low $43.65 Median $44.67 Typical High $63.10 | Facility | None | $43.65 | $44.67 | $63.10 |
Providence Setting Professional Modifier None Typical Low $21.38 Median $42.66 Typical High $79.43 | Professional | None | $21.38 | $42.66 | $79.43 |
Regence BlueShield Setting Professional Modifier None Typical Low $54.95 Median $57.54 Typical High $57.54 | Professional | None | $54.95 | $57.54 | $57.54 |
United Setting Professional Modifier None Typical Low $16.98 Median $21.88 Typical High $41.69 | Professional | None | $16.98 | $21.88 | $41.69 |
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 $19.05 Median $19.05 Typical High $19.05 | Professional | 52 · Reduced service | $19.05 | $19.05 | $19.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | 53 · Discontinued | $7.59 | $7.59 | $7.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | 54 · Surgery only | $28.18 | $28.18 | $28.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.75 Median $5.75 Typical High $5.75 | Professional | 55 · Aftercare only | $5.75 | $5.75 | $5.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.80 Median $3.80 Typical High $3.80 | Professional | 56 · Pre-op care only | $3.80 | $3.80 | $3.80 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $19.05 Median $19.05 Typical High $19.05 | Professional | 52 · Reduced service | $19.05 | $19.05 | $19.05 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | 53 · Discontinued | $7.59 | $7.59 | $7.59 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | 54 · Surgery only | $28.18 | $28.18 | $28.18 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $5.75 Median $5.75 Typical High $5.75 | Professional | 55 · Aftercare only | $5.75 | $5.75 | $5.75 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $3.80 Median $3.80 Typical High $3.80 | Professional | 56 · Pre-op care only | $3.80 | $3.80 | $3.80 |
Where Oregon sits
The same service costs 2.6 times more in Hawaii 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· 22nd of 51
$38.02
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.