How much rates vary
Facilitymedian $1,778 · 10th to 90th $1,738 to $4,898Professionalmedian $1,862 · 10th to 90th $85 to $2,138
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 $1,096.48 Median $1,258.93 Typical High $3,467.37 | Professional | None | $1,096.48 | $1,258.93 | $3,467.37 |
BCBS Montana Setting Facility Modifier None Typical Low $5,495.41 Median $5,495.41 Typical High $5,495.41 | Facility | None | $5,495.41 | $5,495.41 | $5,495.41 |
BCBS Montana Setting Professional Modifier None Typical Low $1,698.24 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,698.24 | $1,698.24 | $1,698.24 |
Cigna Setting Facility Modifier None Typical Low $1,862.09 Median $4,897.79 Typical High $13,803.84 | Facility | None | $1,862.09 | $4,897.79 | $13,803.84 |
Cigna Setting Professional Modifier None Typical Low $1,258.93 Median $1,862.09 Typical High $1,995.26 | Professional | None | $1,258.93 | $1,862.09 | $1,995.26 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $1,737.80 Median $1,778.28 Typical High $1,995.26 | Facility | None | $1,737.80 | $1,778.28 | $1,995.26 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,122.02 Median $1,737.80 Typical High $1,862.09 | Professional | None | $1,122.02 | $1,737.80 | $1,862.09 |
Providence Setting Facility Modifier None Typical Low $1,862.09 Median $4,897.79 Typical High $13,803.84 | Facility | None | $1,862.09 | $4,897.79 | $13,803.84 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $1,698.24 Typical High $1,905.46 | Professional | None | $79.43 | $1,698.24 | $1,905.46 |
United Setting Facility Modifier None Typical Low $2,089.30 Median $3,981.07 Typical High $7,079.46 | Facility | None | $2,089.30 | $3,981.07 | $7,079.46 |
United Setting Professional Modifier None Typical Low $1,698.24 Median $1,949.84 Typical High $2,290.87 | Professional | None | $1,698.24 | $1,949.84 | $2,290.87 |
6 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 $562.34 Median $1,737.80 Typical High $1,737.80 | Professional | 52 · Reduced service | $562.34 | $1,737.80 | $1,737.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $691.83 Typical High $691.83 | Professional | 53 · Discontinued | $223.87 | $691.83 | $691.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $2,630.27 Typical High $2,630.27 | Professional | 54 · Surgery only | $831.76 | $2,630.27 | $2,630.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $524.81 Typical High $524.81 | Professional | 55 · Aftercare only | $165.96 | $524.81 | $524.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $346.74 Typical High $346.74 | Professional | 56 · Pre-op care only | $112.20 | $346.74 | $346.74 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $2,454.71 Typical High $2,454.71 | Professional | 78 · Unplanned return to OR | $776.25 | $2,454.71 | $2,454.71 |
Where Montana sits
The same service costs 3.0 times more in Oklahoma than in Montana. 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
OK $10,899MT $3,640
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.