How much rates vary
Facilitymedian $2,512 · 10th to 90th $1,445 to $2,754Professionalmedian $2,512 · 10th to 90th $437 to $2,951
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 $1,412.54 Median $1,659.59 Typical High $4,570.88 | Professional | None | $1,412.54 | $1,659.59 | $4,570.88 |
BCBS Montana Setting Professional Modifier None Typical Low $2,137.96 Median $2,511.89 Typical High $2,511.89 | Professional | None | $2,137.96 | $2,511.89 | $2,511.89 |
Cigna Setting Facility Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $2,511.89 | Facility | None | $2,511.89 | $2,511.89 | $2,511.89 |
Cigna Setting Professional Modifier None Typical Low $1,659.59 Median $2,511.89 Typical High $2,691.53 | Professional | None | $1,659.59 | $2,511.89 | $2,691.53 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $2,238.72 Median $2,511.89 Typical High $2,951.21 | Facility | None | $2,238.72 | $2,511.89 | $2,951.21 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,659.59 Median $2,511.89 Typical High $2,691.53 | Professional | None | $1,659.59 | $2,511.89 | $2,691.53 |
Providence Setting Facility Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $2,511.89 | Facility | None | $2,511.89 | $2,511.89 | $2,511.89 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $2,290.87 Typical High $2,570.40 | Professional | None | $79.43 | $2,290.87 | $2,570.40 |
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 $2,238.72 Median $2,630.27 Typical High $3,019.95 | Professional | None | $2,238.72 | $2,630.27 | $3,019.95 |
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 $741.31 Median $2,290.87 Typical High $2,290.87 | Professional | 52 · Reduced service | $741.31 | $2,290.87 | $2,290.87 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $912.01 Typical High $912.01 | Professional | 53 · Discontinued | $295.12 | $912.01 | $912.01 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $3,467.37 Typical High $3,467.37 | Professional | 54 · Surgery only | $1,096.48 | $3,467.37 | $3,467.37 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $218.78 Median $691.83 Typical High $691.83 | Professional | 55 · Aftercare only | $218.78 | $691.83 | $691.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $457.09 Typical High $457.09 | Professional | 56 · Pre-op care only | $147.91 | $457.09 | $457.09 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $3,235.94 Typical High $3,235.94 | Professional | 78 · Unplanned return to OR | $1,023.29 | $3,235.94 | $3,235.94 |
Where Montana sits
The same service costs 8.1 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 $17,891MD $2,222
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.