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 $512,861.38 Median $588,843.66 Typical High $630,957.34 | Professional | None | $512,861.38 | $588,843.66 | $630,957.34 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $512,861.38 Median $630,957.34 Typical High $630,957.34 | Facility | None | $512,861.38 | $630,957.34 | $630,957.34 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $630,957.34 Median $630,957.34 Typical High $691,830.97 | Professional | None | $630,957.34 | $630,957.34 | $691,830.97 |
Providence Setting Professional Modifier None Typical Low $79.43 Median $549,540.87 Typical High $616,595.00 | Professional | None | $79.43 | $549,540.87 | $616,595.00 |
United Setting Professional Modifier None Typical Low $489,778.82 Median $489,778.82 Typical High $489,778.82 | Professional | None | $489,778.82 | $489,778.82 | $489,778.82 |
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 $257,039.58 Median $295,120.92 Typical High $316,227.77 | Professional | 52 · Reduced service | $257,039.58 | $295,120.92 | $316,227.77 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $102,329.30 Median $117,489.76 Typical High $128,824.96 | Professional | 53 · Discontinued | $102,329.30 | $117,489.76 | $128,824.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $75,857.76 Median $89,125.09 Typical High $95,499.26 | Professional | 55 · Aftercare only | $75,857.76 | $89,125.09 | $95,499.26 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $51,286.14 Median $58,884.37 Typical High $63,095.73 | Professional | 56 · Pre-op care only | $51,286.14 | $58,884.37 | $63,095.73 |
Where Montana sits
The same service costs 2.0 times more in Texas than in New Jersey. 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· 13th of 51
$549,541
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.