How much rates vary
Facilitymedian $3,162 · 10th to 90th $1,445 to $3,467Professionalmedian $3,162 · 10th to 90th $85 to $3,715
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 $1,819.70 Median $5,754.40 Typical High $5,754.40 | Professional | None | $1,819.70 | $5,754.40 | $5,754.40 |
BCBS Montana Setting Professional Modifier None Typical Low $3,162.28 Median $3,162.28 Typical High $3,162.28 | Professional | None | $3,162.28 | $3,162.28 | $3,162.28 |
Cigna Setting Facility Modifier None Typical Low $3,162.28 Median $3,162.28 Typical High $3,162.28 | Facility | None | $3,162.28 | $3,162.28 | $3,162.28 |
Cigna Setting Professional Modifier None Typical Low $2,089.30 Median $3,162.28 Typical High $3,388.44 | Professional | None | $2,089.30 | $3,162.28 | $3,388.44 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $2,818.38 Median $3,162.28 Typical High $3,630.78 | Facility | None | $2,818.38 | $3,162.28 | $3,630.78 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $2,041.74 Median $3,162.28 Typical High $3,388.44 | Professional | None | $2,041.74 | $3,162.28 | $3,388.44 |
Providence Setting Facility Modifier None Typical Low $3,162.28 Median $3,162.28 Typical High $3,162.28 | Facility | None | $3,162.28 | $3,162.28 | $3,162.28 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $2,884.03 Typical High $3,235.94 | Professional | None | $79.43 | $2,884.03 | $3,235.94 |
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 $2,818.38 Median $3,311.31 Typical High $3,890.45 | Professional | None | $2,818.38 | $3,311.31 | $3,890.45 |
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 $912.01 Median $2,884.03 Typical High $2,884.03 | Professional | 52 · Reduced service | $912.01 | $2,884.03 | $2,884.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $363.08 Median $1,148.15 Typical High $1,148.15 | Professional | 53 · Discontinued | $363.08 | $1,148.15 | $1,148.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,380.38 Median $4,265.80 Typical High $4,265.80 | Professional | 54 · Surgery only | $1,380.38 | $4,265.80 | $4,265.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $275.42 Median $851.14 Typical High $851.14 | Professional | 55 · Aftercare only | $275.42 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $181.97 Median $575.44 Typical High $575.44 | Professional | 56 · Pre-op care only | $181.97 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,288.25 Median $3,981.07 Typical High $3,981.07 | Professional | 78 · Unplanned return to OR | $1,288.25 | $3,981.07 | $3,981.07 |
Where Montana sits
The same service costs 6.9 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 $18,419MD $2,652
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.