How much rates vary
Facilitymedian $2,818 · 10th to 90th $1,445 to $3,020Professionalmedian $2,754 · 10th to 90th $85 to $3,236
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 $1,621.81 Median $2,187.76 Typical High $5,011.87 | Professional | None | $1,621.81 | $2,187.76 | $5,011.87 |
BCBS Montana Setting Professional Modifier None Typical Low $2,344.23 Median $2,754.23 Typical High $2,754.23 | Professional | None | $2,344.23 | $2,754.23 | $2,754.23 |
Cigna Setting Facility Modifier None Typical Low $2,754.23 Median $2,754.23 Typical High $2,754.23 | Facility | None | $2,754.23 | $2,754.23 | $2,754.23 |
Cigna Setting Professional Modifier None Typical Low $1,819.70 Median $2,754.23 Typical High $2,951.21 | Professional | None | $1,819.70 | $2,754.23 | $2,951.21 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $2,511.89 Median $2,818.38 Typical High $3,235.94 | Facility | None | $2,511.89 | $2,818.38 | $3,235.94 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,819.70 Median $2,818.38 Typical High $2,951.21 | Professional | None | $1,819.70 | $2,818.38 | $2,951.21 |
Providence Setting Facility Modifier None Typical Low $2,754.23 Median $2,754.23 Typical High $2,754.23 | Facility | None | $2,754.23 | $2,754.23 | $2,754.23 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $2,570.40 Typical High $2,818.38 | Professional | None | $79.43 | $2,570.40 | $2,818.38 |
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 $2,454.71 Median $2,951.21 Typical High $3,467.37 | Professional | None | $2,454.71 | $2,951.21 | $3,467.37 |
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 $812.83 Median $2,511.89 Typical High $2,511.89 | Professional | 52 · Reduced service | $812.83 | $2,511.89 | $2,511.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $1,023.29 Typical High $1,023.29 | Professional | 53 · Discontinued | $323.59 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $3,801.89 Typical High $3,801.89 | Professional | 54 · Surgery only | $1,202.26 | $3,801.89 | $3,801.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $758.58 Typical High $758.58 | Professional | 55 · Aftercare only | $239.88 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $501.19 Typical High $501.19 | Professional | 56 · Pre-op care only | $162.18 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $3,548.13 Typical High $3,548.13 | Professional | 78 · Unplanned return to OR | $1,122.02 | $3,548.13 | $3,548.13 |
Where Montana sits
The same service costs 7.6 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 $18,140MD $2,382
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.