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 $75.86 Median $85.11 Typical High $95.50 | Professional | None | $75.86 | $85.11 | $95.50 |
BCBS Montana Setting Facility Modifier None Typical Low $75.86 Median $75.86 Typical High $144.54 | Facility | None | $75.86 | $75.86 | $144.54 |
Cigna Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $181.97 | Facility | None | $89.13 | $89.13 | $181.97 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $89.13 Typical High $89.13 | Professional | None | $75.86 | $89.13 | $89.13 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $75.86 Median $93.33 Typical High $123.03 | Facility | None | $75.86 | $93.33 | $123.03 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $75.86 Median $95.50 Typical High $102.33 | Professional | None | $75.86 | $95.50 | $102.33 |
Providence Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $181.97 | Facility | None | $89.13 | $89.13 | $181.97 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $89.13 Typical High $97.72 | Professional | None | $79.43 | $89.13 | $97.72 |
United Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | None | $75.86 | $75.86 | $75.86 |
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 $38.02 Median $44.67 Typical High $47.86 | Professional | 52 · Reduced service | $38.02 | $44.67 | $47.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.14 Median $17.78 Typical High $19.05 | Professional | 53 · Discontinued | $15.14 | $17.78 | $19.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $66.07 Typical High $72.44 | Professional | 54 · Surgery only | $57.54 | $66.07 | $72.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $13.18 Typical High $14.45 | Professional | 55 · Aftercare only | $11.48 | $13.18 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $8.91 Typical High $9.55 | Professional | 56 · Pre-op care only | $7.59 | $8.91 | $9.55 |
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· 3rd of 51
$89.13
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.