How much rates vary
Facilitymedian $1,122 · 10th to 90th $955 to $4,571Professionalmedian $1,072 · 10th to 90th $85 to $1,259
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 $602.56 Median $691.83 Typical High $1,949.84 | Professional | None | $602.56 | $691.83 | $1,949.84 |
BCBS Montana Setting Professional Modifier None Typical Low $1,071.52 Median $1,071.52 Typical High $1,288.25 | Professional | None | $1,071.52 | $1,071.52 | $1,288.25 |
Cigna Setting Facility Modifier None Typical Low $1,071.52 Median $4,897.79 Typical High $13,803.84 | Facility | None | $1,071.52 | $4,897.79 | $13,803.84 |
Cigna Setting Professional Modifier None Typical Low $707.95 Median $1,071.52 Typical High $1,122.02 | Professional | None | $707.95 | $1,071.52 | $1,122.02 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $954.99 Median $1,096.48 Typical High $1,258.93 | Facility | None | $954.99 | $1,096.48 | $1,258.93 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $707.95 Median $1,096.48 Typical High $1,174.90 | Professional | None | $707.95 | $1,096.48 | $1,174.90 |
Providence Setting Facility Modifier None Typical Low $1,071.52 Median $4,897.79 Typical High $13,803.84 | Facility | None | $1,071.52 | $4,897.79 | $13,803.84 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $977.24 Typical High $1,096.48 | Professional | None | $79.43 | $977.24 | $1,096.48 |
United Setting Facility Modifier None Typical Low $1,479.11 Median $2,884.03 Typical High $4,570.88 | Facility | None | $1,479.11 | $2,884.03 | $4,570.88 |
United Setting Professional Modifier None Typical Low $954.99 Median $1,122.02 Typical High $1,318.26 | Professional | None | $954.99 | $1,122.02 | $1,318.26 |
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 $309.03 Median $977.24 Typical High $977.24 | Professional | 52 · Reduced service | $309.03 | $977.24 | $977.24 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $125.89 Median $389.05 Typical High $389.05 | Professional | 53 · Discontinued | $125.89 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $467.74 Median $1,479.11 Typical High $1,479.11 | Professional | 54 · Surgery only | $467.74 | $1,479.11 | $1,479.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $93.33 Median $295.12 Typical High $295.12 | Professional | 55 · Aftercare only | $93.33 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $63.10 Median $194.98 Typical High $194.98 | Professional | 56 · Pre-op care only | $63.10 | $194.98 | $194.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $436.52 Median $1,380.38 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $436.52 | $1,380.38 | $1,380.38 |
Where Montana sits
The same service costs 4.3 times more in Colorado than in Montana. 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
CO $9,423MT $2,194
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.