How much rates vary
Facilitymedian $380 · 10th to 90th $204 to $708Professionalmedian $398 · 10th to 90th $191 to $708
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 Facility Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $4,265.80 | Facility | None | $2,089.30 | $2,089.30 | $4,265.80 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $275.42 Typical High $489.78 | Professional | None | $162.18 | $275.42 | $489.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $81.28 Typical High $165.96 | Professional | 53 · Discontinued | $32.36 | $81.28 | $165.96 |
BCBS Montana Setting Facility Modifier None Typical Low $977.24 Median $977.24 Typical High $977.24 | Facility | None | $977.24 | $977.24 | $977.24 |
BCBS Montana Setting Professional Modifier None Typical Low $288.40 Median $478.63 Typical High $537.03 | Professional | None | $288.40 | $478.63 | $537.03 |
Cigna Setting Facility Modifier None Typical Low $288.40 Median $812.83 Typical High $2,344.23 | Facility | None | $288.40 | $812.83 | $2,344.23 |
Cigna Setting Professional Modifier None Typical Low $288.40 Median $302.00 Typical High $537.03 | Professional | None | $288.40 | $302.00 | $537.03 |
Cigna Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $144.54 Typical High $269.15 | Professional | 53 · Discontinued | $144.54 | $144.54 | $269.15 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $204.17 Median $331.13 Typical High $660.69 | Facility | None | $204.17 | $331.13 | $660.69 |
MountainHealth Co-op Setting Facility Modifier 53 · Discontinued Typical Low $83.18 Median $112.20 Typical High $234.42 | Facility | 53 · Discontinued | $83.18 | $112.20 | $234.42 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $165.96 Median $309.03 Typical High $691.83 | Professional | None | $165.96 | $309.03 | $691.83 |
MountainHealth Co-op Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $102.33 Typical High $234.42 | Professional | 53 · Discontinued | $83.18 | $102.33 | $234.42 |
Providence Setting Facility Modifier None Typical Low $288.40 Median $812.83 Typical High $2,344.23 | Facility | None | $288.40 | $812.83 | $2,344.23 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $436.52 Typical High $831.76 | Professional | None | $79.43 | $436.52 | $831.76 |
Providence Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $144.54 Typical High $269.15 | Professional | 53 · Discontinued | $144.54 | $144.54 | $269.15 |
United Setting Facility Modifier None Typical Low $398.11 Median $616.60 Typical High $954.99 | Facility | None | $398.11 | $616.60 | $954.99 |
United Setting Professional Modifier None Typical Low $295.12 Median $436.52 Typical High $616.60 | Professional | None | $295.12 | $436.52 | $616.60 |
4 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 $81.28 Median $138.04 Typical High $177.83 | Professional | 52 · Reduced service | $81.28 | $138.04 | $177.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $120.23 Median $204.17 Typical High $269.15 | Professional | 54 · Surgery only | $120.23 | $204.17 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $41.69 Typical High $53.70 | Professional | 55 · Aftercare only | $23.99 | $41.69 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $27.54 Typical High $35.48 | Professional | 56 · Pre-op care only | $16.22 | $27.54 | $35.48 |
Where Montana sits
The same service costs 5.8 times more in Vermont than in Maine. 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
VT $4,478ME $766
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.