How much rates vary
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 $1,000.00 Median $1,148.15 Typical High $3,090.30 | Professional | None | $1,000.00 | $1,148.15 | $3,090.30 |
BCBS Montana Setting Facility Modifier None Typical Low $5,495.41 Median $5,495.41 Typical High $5,495.41 | Facility | None | $5,495.41 | $5,495.41 | $5,495.41 |
Cigna Setting Facility Modifier None Typical Low $1,698.24 Median $4,897.79 Typical High $13,803.84 | Facility | None | $1,698.24 | $4,897.79 | $13,803.84 |
Cigna Setting Professional Modifier None Typical Low $1,071.52 Median $1,698.24 Typical High $1,819.70 | Professional | None | $1,071.52 | $1,698.24 | $1,819.70 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $1,621.81 Median $1,659.59 Typical High $1,905.46 | Facility | None | $1,621.81 | $1,659.59 | $1,905.46 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,071.52 Median $1,659.59 Typical High $1,778.28 | Professional | None | $1,071.52 | $1,659.59 | $1,778.28 |
Providence Setting Facility Modifier None Typical Low $1,698.24 Median $4,897.79 Typical High $13,803.84 | Facility | None | $1,698.24 | $4,897.79 | $13,803.84 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $1,548.82 Typical High $1,737.80 | Professional | None | $79.43 | $1,548.82 | $1,737.80 |
United Setting Facility Modifier None Typical Low $2,089.30 Median $3,981.07 Typical High $7,079.46 | Facility | None | $2,089.30 | $3,981.07 | $7,079.46 |
United Setting Professional Modifier None Typical Low $1,513.56 Median $1,778.28 Typical High $2,137.96 | Professional | None | $1,513.56 | $1,778.28 | $2,137.96 |
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 $501.19 Median $1,548.82 Typical High $1,548.82 | Professional | 52 · Reduced service | $501.19 | $1,548.82 | $1,548.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $616.60 Typical High $616.60 | Professional | 53 · Discontinued | $199.53 | $616.60 | $616.60 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $2,344.23 Typical High $2,344.23 | Professional | 54 · Surgery only | $741.31 | $2,344.23 | $2,344.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $467.74 Typical High $467.74 | Professional | 55 · Aftercare only | $147.91 | $467.74 | $467.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $309.03 Typical High $309.03 | Professional | 56 · Pre-op care only | $100.00 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $2,187.76 Typical High $2,187.76 | Professional | 78 · Unplanned return to OR | $691.83 | $2,187.76 | $2,187.76 |
Where Montana sits
The same service costs 6.2 times more in Alaska than in Texas. 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.
Montana· 14th of 51
$1,698
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.