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 $213.80 Median $302.00 Typical High $891.25 | Professional | None | $213.80 | $302.00 | $891.25 |
BCBS Montana Setting Facility Modifier None Typical Low $2,884.03 Median $2,884.03 Typical High $2,884.03 | Facility | None | $2,884.03 | $2,884.03 | $2,884.03 |
BCBS Montana Setting Professional Modifier None Typical Low $309.03 Median $323.59 Typical High $436.52 | Professional | None | $309.03 | $323.59 | $436.52 |
Cigna Setting Facility Modifier None Typical Low $363.08 Median $1,071.52 Typical High $3,019.95 | Facility | None | $363.08 | $1,071.52 | $3,019.95 |
Cigna Setting Professional Modifier None Typical Low $309.03 Median $380.19 Typical High $489.78 | Professional | None | $309.03 | $380.19 | $489.78 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $338.84 Median $407.38 Typical High $575.44 | Facility | None | $338.84 | $407.38 | $575.44 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $223.87 Median $371.54 Typical High $562.34 | Professional | None | $223.87 | $371.54 | $562.34 |
Providence Setting Facility Modifier None Typical Low $363.08 Median $1,071.52 Typical High $3,019.95 | Facility | None | $363.08 | $1,071.52 | $3,019.95 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $363.08 Typical High $489.78 | Professional | None | $79.43 | $363.08 | $489.78 |
United Setting Facility Modifier None Typical Low $602.56 Median $1,000.00 Typical High $1,862.09 | Facility | None | $602.56 | $1,000.00 | $1,862.09 |
United Setting Professional Modifier None Typical Low $346.74 Median $436.52 Typical High $549.54 | Professional | None | $346.74 | $436.52 | $549.54 |
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 $112.20 Median $331.13 Typical High $446.68 | Professional | 52 · Reduced service | $112.20 | $331.13 | $446.68 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $44.67 Median $131.83 Typical High $177.83 | Professional | 53 · Discontinued | $44.67 | $131.83 | $177.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $165.96 Median $501.19 Typical High $660.69 | Professional | 54 · Surgery only | $165.96 | $501.19 | $660.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.11 Median $100.00 Typical High $131.83 | Professional | 55 · Aftercare only | $33.11 | $100.00 | $131.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.39 Median $66.07 Typical High $89.13 | Professional | 56 · Pre-op care only | $22.39 | $66.07 | $89.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $154.88 Median $467.74 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $154.88 | $467.74 | $616.60 |
Where Montana sits
The same service costs 4.3 times more in Alaska than in Utah. 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· 18th of 51
$372
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.