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 $56.23 Median $66.07 Typical High $70.79 | Professional | None | $56.23 | $66.07 | $70.79 |
Cigna Setting Facility Modifier None Typical Low $58.88 Median $58.88 Typical High $58.88 | Facility | None | $58.88 | $58.88 | $58.88 |
Cigna Setting Professional Modifier None Typical Low $56.23 Median $58.88 Typical High $58.88 | Professional | None | $56.23 | $58.88 | $58.88 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $53.70 Median $66.07 Typical High $75.86 | Facility | None | $53.70 | $66.07 | $75.86 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $53.70 Median $69.18 Typical High $75.86 | Professional | None | $53.70 | $69.18 | $75.86 |
Providence Setting Facility Modifier None Typical Low $58.88 Median $58.88 Typical High $58.88 | Facility | None | $58.88 | $58.88 | $58.88 |
Providence Setting Professional Modifier None Typical Low $58.88 Median $72.44 Typical High $79.43 | Professional | None | $58.88 | $72.44 | $79.43 |
United Setting Professional Modifier None Typical Low $53.70 Median $53.70 Typical High $53.70 | Professional | None | $53.70 | $53.70 | $53.70 |
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 $28.18 Median $33.11 Typical High $35.48 | Professional | 52 · Reduced service | $28.18 | $33.11 | $35.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.22 Median $13.18 Typical High $14.13 | Professional | 53 · Discontinued | $11.22 | $13.18 | $14.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $9.77 Typical High $10.47 | Professional | 55 · Aftercare only | $8.51 | $9.77 | $10.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.62 Median $6.61 Typical High $7.08 | Professional | 56 · Pre-op care only | $5.62 | $6.61 | $7.08 |
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· 6th of 51
$58.88
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.