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 $229.09 Median $263.03 Typical High $281.84 | Professional | None | $229.09 | $263.03 | $281.84 |
Cigna Setting Facility Modifier None Typical Low $263.03 Median $263.03 Typical High $263.03 | Facility | None | $263.03 | $263.03 | $263.03 |
Cigna Setting Professional Modifier None Typical Low $229.09 Median $263.03 Typical High $263.03 | Professional | None | $229.09 | $263.03 | $263.03 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $223.87 Median $275.42 Typical High $309.03 | Facility | None | $223.87 | $275.42 | $309.03 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $223.87 Median $281.84 Typical High $309.03 | Professional | None | $223.87 | $281.84 | $309.03 |
Providence Setting Facility Modifier None Typical Low $263.03 Median $263.03 Typical High $263.03 | Facility | None | $263.03 | $263.03 | $263.03 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $263.03 Typical High $288.40 | Professional | None | $79.43 | $263.03 | $288.40 |
United Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | None | $223.87 | $223.87 | $223.87 |
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 $114.82 Median $131.83 Typical High $141.25 | Professional | 52 · Reduced service | $114.82 | $131.83 | $141.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $52.48 Typical High $57.54 | Professional | 53 · Discontinued | $45.71 | $52.48 | $57.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $39.81 Typical High $42.66 | Professional | 55 · Aftercare only | $33.88 | $39.81 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.91 Median $26.30 Typical High $28.18 | Professional | 56 · Pre-op care only | $22.91 | $26.30 | $28.18 |
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· 2nd of 51
$263
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.