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 $562,341.33 Median $645,654.23 Typical High $707,945.78 | Professional | None | $562,341.33 | $645,654.23 | $707,945.78 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $562,341.33 Median $707,945.78 Typical High $707,945.78 | Facility | None | $562,341.33 | $707,945.78 | $707,945.78 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $707,945.78 Median $707,945.78 Typical High $758,577.58 | Professional | None | $707,945.78 | $707,945.78 | $758,577.58 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $616,595.00 Typical High $616,595.00 | Professional | None | $79.43 | $616,595.00 | $616,595.00 |
United Setting Professional Modifier None Typical Low $537,031.80 Median $537,031.80 Typical High $537,031.80 | Professional | None | $537,031.80 | $537,031.80 | $537,031.80 |
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 $281,838.29 Median $323,593.66 Typical High $354,813.39 | Professional | 52 · Reduced service | $281,838.29 | $323,593.66 | $354,813.39 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $112,201.85 Median $131,825.67 Typical High $141,253.75 | Professional | 53 · Discontinued | $112,201.85 | $131,825.67 | $141,253.75 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $85,113.80 Median $97,723.72 Typical High $104,712.85 | Professional | 55 · Aftercare only | $85,113.80 | $97,723.72 | $104,712.85 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $56,234.13 Median $64,565.42 Typical High $70,794.58 | Professional | 56 · Pre-op care only | $56,234.13 | $64,565.42 | $70,794.58 |
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
$616,595
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.