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 $17.38 Median $19.05 Typical High $19.50 | Professional | None | $17.38 | $19.05 | $19.50 |
Cigna Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $10.72 | Professional | None | $10.72 | $10.72 | $10.72 |
Kaiser Permanente Setting Professional Modifier None Typical Low $42.66 Median $50.12 Typical High $151.36 | Professional | None | $42.66 | $50.12 | $151.36 |
Moda Health Setting Facility Modifier None Typical Low $19.05 Median $25.12 Typical High $26.92 | Facility | None | $19.05 | $25.12 | $26.92 |
Moda Health Setting Professional Modifier None Typical Low $19.05 Median $23.99 Typical High $26.92 | Professional | None | $19.05 | $23.99 | $26.92 |
Pacific Source Setting Facility Modifier None Typical Low $22.91 Median $25.12 Typical High $25.70 | Facility | None | $22.91 | $25.12 | $25.70 |
Providence Setting Facility Modifier None Typical Low $21.88 Median $22.39 Typical High $31.62 | Facility | None | $21.88 | $22.39 | $31.62 |
Providence Setting Professional Modifier None Typical Low $10.72 Median $21.38 Typical High $79.43 | Professional | None | $10.72 | $21.38 | $79.43 |
Regence BlueShield Setting Professional Modifier None Typical Low $27.54 Median $28.84 Typical High $28.84 | Professional | None | $27.54 | $28.84 | $28.84 |
United Setting Professional Modifier None Typical Low $8.51 Median $10.96 Typical High $20.89 | Professional | None | $8.51 | $10.96 | $20.89 |
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 $9.55 Median $9.55 Typical High $9.55 | Professional | 52 · Reduced service | $9.55 | $9.55 | $9.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.80 Median $3.80 Typical High $3.80 | Professional | 53 · Discontinued | $3.80 | $3.80 | $3.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $14.13 Median $14.13 Typical High $14.13 | Professional | 54 · Surgery only | $14.13 | $14.13 | $14.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.82 Median $2.82 Typical High $2.82 | Professional | 55 · Aftercare only | $2.82 | $2.82 | $2.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.91 Median $1.91 Typical High $1.91 | Professional | 56 · Pre-op care only | $1.91 | $1.91 | $1.91 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | 52 · Reduced service | $9.55 | $9.55 | $9.55 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $3.80 Median $3.80 Typical High $3.80 | Professional | 53 · Discontinued | $3.80 | $3.80 | $3.80 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $14.13 Median $14.13 Typical High $14.13 | Professional | 54 · Surgery only | $14.13 | $14.13 | $14.13 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $2.82 Median $2.82 Typical High $2.82 | Professional | 55 · Aftercare only | $2.82 | $2.82 | $2.82 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $1.91 Median $1.91 Typical High $1.91 | Professional | 56 · Pre-op care only | $1.91 | $1.91 | $1.91 |
Where Oregon sits
The same service costs 3.5 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· 22nd of 51
$19.05
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.