How much rates vary
Facilitymedian $2,630 · 10th to 90th $1,445 to $2,884Professionalmedian $2,630 · 10th to 90th $85 to $3,020
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 $1,513.56 Median $4,786.30 Typical High $4,786.30 | Professional | None | $1,513.56 | $4,786.30 | $4,786.30 |
BCBS Montana Setting Professional Modifier None Typical Low $2,630.27 Median $2,630.27 Typical High $2,630.27 | Professional | None | $2,630.27 | $2,630.27 | $2,630.27 |
Cigna Setting Facility Modifier None Typical Low $2,630.27 Median $2,630.27 Typical High $2,630.27 | Facility | None | $2,630.27 | $2,630.27 | $2,630.27 |
Cigna Setting Professional Modifier None Typical Low $1,698.24 Median $2,630.27 Typical High $2,691.53 | Professional | None | $1,698.24 | $2,630.27 | $2,691.53 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $2,290.87 Median $2,630.27 Typical High $3,019.95 | Facility | None | $2,290.87 | $2,630.27 | $3,019.95 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,698.24 Median $2,630.27 Typical High $2,818.38 | Professional | None | $1,698.24 | $2,630.27 | $2,818.38 |
Providence Setting Facility Modifier None Typical Low $2,630.27 Median $2,630.27 Typical High $2,630.27 | Facility | None | $2,630.27 | $2,630.27 | $2,630.27 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $2,398.83 Typical High $2,691.53 | Professional | None | $79.43 | $2,398.83 | $2,691.53 |
United Setting Facility Modifier None Typical Low $602.56 Median $954.99 Typical High $1,862.09 | Facility | None | $602.56 | $954.99 | $1,862.09 |
United Setting Professional Modifier None Typical Low $2,290.87 Median $2,691.53 Typical High $3,162.28 | Professional | None | $2,290.87 | $2,691.53 | $3,162.28 |
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 $758.58 Median $2,344.23 Typical High $2,344.23 | Professional | 52 · Reduced service | $758.58 | $2,344.23 | $2,344.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $954.99 Typical High $954.99 | Professional | 53 · Discontinued | $302.00 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $3,548.13 Typical High $3,548.13 | Professional | 54 · Surgery only | $1,148.15 | $3,548.13 | $3,548.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $707.95 Typical High $707.95 | Professional | 55 · Aftercare only | $229.09 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $478.63 Typical High $478.63 | Professional | 56 · Pre-op care only | $151.36 | $478.63 | $478.63 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $3,311.31 Typical High $3,311.31 | Professional | 78 · Unplanned return to OR | $1,071.52 | $3,311.31 | $3,311.31 |
Where Montana sits
The same service costs 7.8 times more in Maine than in Maryland. 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
ME $17,987MD $2,300
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.