How much rates vary
Facilitymedian $1,622 · 10th to 90th $1,000 to $1,862Professionalmedian $1,585 · 10th to 90th $85 to $1,862
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 $933.25 Median $1,318.26 Typical High $2,884.03 | Professional | None | $933.25 | $1,318.26 | $2,884.03 |
BCBS Montana Setting Professional Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $1,905.46 | Professional | None | $1,584.89 | $1,584.89 | $1,905.46 |
Cigna Setting Facility Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $1,584.89 | Facility | None | $1,584.89 | $1,584.89 | $1,584.89 |
Cigna Setting Professional Modifier None Typical Low $1,047.13 Median $1,584.89 Typical High $1,698.24 | Professional | None | $1,047.13 | $1,584.89 | $1,698.24 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $1,412.54 Median $1,621.81 Typical High $1,862.09 | Facility | None | $1,412.54 | $1,621.81 | $1,862.09 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,071.52 Median $1,621.81 Typical High $1,737.80 | Professional | None | $1,071.52 | $1,621.81 | $1,737.80 |
Providence Setting Facility Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $1,584.89 | Facility | None | $1,584.89 | $1,584.89 | $1,584.89 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $1,445.44 Typical High $1,621.81 | Professional | None | $79.43 | $1,445.44 | $1,621.81 |
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 $1,412.54 Median $1,659.59 Typical High $1,949.84 | Professional | None | $1,412.54 | $1,659.59 | $1,949.84 |
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 $467.74 Median $1,445.44 Typical High $1,445.44 | Professional | 52 · Reduced service | $467.74 | $1,445.44 | $1,445.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $186.21 Median $575.44 Typical High $575.44 | Professional | 53 · Discontinued | $186.21 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $691.83 Median $2,187.76 Typical High $2,187.76 | Professional | 54 · Surgery only | $691.83 | $2,187.76 | $2,187.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $138.04 Median $436.52 Typical High $436.52 | Professional | 55 · Aftercare only | $138.04 | $436.52 | $436.52 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $93.33 Median $288.40 Typical High $288.40 | Professional | 56 · Pre-op care only | $93.33 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $645.65 Median $2,041.74 Typical High $2,041.74 | Professional | 78 · Unplanned return to OR | $645.65 | $2,041.74 | $2,041.74 |
Where Montana sits
The same service costs 10.6 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 $17,137MD $1,609
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.