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 $173.78 Median $199.53 Typical High $213.80 | Professional | None | $173.78 | $199.53 | $213.80 |
BCBS Montana Setting Facility Modifier None Typical Low $218.78 Median $257.04 Typical High $275.42 | Facility | None | $218.78 | $257.04 | $275.42 |
Cigna Setting Facility Modifier None Typical Low $186.21 Median $186.21 Typical High $346.74 | Facility | None | $186.21 | $186.21 | $346.74 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $186.21 Typical High $186.21 | Professional | None | $173.78 | $186.21 | $186.21 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $162.18 Median $204.17 Typical High $269.15 | Facility | None | $162.18 | $204.17 | $269.15 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $162.18 Median $213.80 Typical High $234.42 | Professional | None | $162.18 | $213.80 | $234.42 |
Providence Setting Facility Modifier None Typical Low $186.21 Median $186.21 Typical High $346.74 | Facility | None | $186.21 | $186.21 | $346.74 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $186.21 Typical High $218.78 | Professional | None | $79.43 | $186.21 | $218.78 |
United Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
5 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 $87.10 Median $100.00 Typical High $107.15 | Professional | 52 · Reduced service | $87.10 | $100.00 | $107.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $39.81 Typical High $43.65 | Professional | 53 · Discontinued | $34.67 | $39.81 | $43.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $151.36 Typical High $162.18 | Professional | 54 · Surgery only | $128.82 | $151.36 | $162.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $30.20 Typical High $32.36 | Professional | 55 · Aftercare only | $25.70 | $30.20 | $32.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $19.95 Typical High $21.38 | Professional | 56 · Pre-op care only | $17.38 | $19.95 | $21.38 |
Where Montana sits
Rates are fairly even across states for this service. 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· 5th of 51
$186
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.