Montana · state market

Commercial healthcare reimbursement in Montana

How Montana compares with the nation, by payer, specialty and procedure.

State indexSnapshot Aug 2026

Montana at a glance

228 procedure codes, 8 specialties

Index vs national

100

0% below the national median

State rank

24 of 51

1 = highest

Median % of Medicare

160%

across tracked codes

Payers

448 sampled providers

What the data shows

Generated from this state's numbers

Montana ranks 24th of 51 states for commercial reimbursement, with an index of 100 (100 = national median) across 228 procedure codes; the West region averages 118.

Commercial rates in Montana run a median 160% of Medicare.

Aetna has the highest index in the state (123) and Blue Cross Blue Shield the lowest (100), a 23-point gap, in the files analyzed.

CPT 93298 (Rem interrog dev eval scrms) is the strongest relative to the national median (307% of it, a 207% premium); CPT 52000 (Cystourethroscopy) is furthest below (60% of the national median, 40% lower).

By specialty, Montana is strongest for ophthalmology (ranks 12th of 50 states for that specialty) and weakest for gastroenterology (39th of 50).

Against Medicare, gastroenterology has the highest ratio in Montana (174% of Medicare) and dermatology the lowest (109%).

Payer ranking in Montana

Index: 100 = the four-payer state median; counts are sampled providers and TINs

Payer	Index	Rank	Codes	Providers	TINs
Aetna	123	1	54	80	111
UnitedHealthcare	114	2	228	323	177
Cigna	100	3	227	367	190
Blue Cross Blue Shield	100	3	227	409	248

Reimbursement index by specialty in Montana

100 = the specialty's national median; the Medicare column compares median rates with the CY2026 Medicare rate

Specialty	Index	Rank among states	% of Medicare	Codes	Providers
Ophthalmology	125	12 of 50	149%	42	36
Diagnostic radiology	107	18 of 51	161%	49	70
Dermatology	108	18 of 50	109%	44	44
Internal medicine	106	21 of 51	118%	25	103
Cardiology	102	22 of 51	156%	38	49
Orthopedic surgery	97	28 of 51	159%	39	79
Urology	96	31 of 50	155%	37	39
Gastroenterology	90	39 of 50	174%	36	28

Specialty by payer in Montana

Index: 100 = the specialty's national median for the same codes; bold = highest payer for that specialty; n/a = fewer than 10 codes with enough data

Specialty	UHC	Aetna	Cigna	BCBS
Internal medicine	126	n/a	107	106
Dermatology	176	n/a	111	108
Ophthalmology	156	n/a	125	118
Cardiology	116	n/a	101	99
Orthopedic surgery	105	n/a	100	96
Diagnostic radiology	94	129	106	96
Urology	122	n/a	99	74
Gastroenterology	123	n/a	93	90

Montana compared with West region states

Closest states in the West region by index; the region averages 118

State	Index	Rank	% of Medicare	Providers
Montana	100	24	160%	448
Utah	100	25	154%	818
Hawaii	102	21	138%	524
Colorado	105	19	162%	948
New Mexico	94	33	141%	622
California	93	35	138%	844

Procedures that pay most and least in Montana vs the nation

Median across payers; the 15 largest gaps in each direction

Highest vs national

Code	Montana	National	Gap	Prov.
93298 Rem interrog dev eval scrms	$160	$52	+207%	49
93297 Rem interrog dev eval icpms	$95	$52	+82%	48
96910 Photchmtx tar&uvb/ptrltm&uvb	$187	$125	+50%	44
97110 Therapeutic exercises	$46	$31	+47%	79
92242 Fluorescein&icg angiography	$423	$288	+47%	36
92025 Cptrized corneal topography	$57	$40	+43%	36
92134 Cptrz oph dx img pst sgm rta	$64	$45	+42%	36
92273 Full field erg w/i&r	$199	$142	+40%	34
96574 Dbrdmt prmlg les w/pdt	$438	$315	+39%	44
92083 Extended visual field xm	$100	$73	+37%	36
92133 Cptrzd oph dx img pst sgm on	$57	$42	+35%	36
65820 Goniotomy	$1,290	$955	+35%	36
92202 Opscpy extnd on/mac draw	$23	$17	+34%	36
92201 Opscpy extnd rta draw uni/bi	$35	$27	+33%	36
99490 Chrnc care mgmt staff 1st 20	$78	$60	+30%	216

Lowest vs national

Code	Montana	National	Gap	Prov.
52000 Cystourethroscopy	$125	$210	-40%	39
51700 Irrigation of bladder	$47	$77	-39%	39
51720 Treatment of bladder lesion	$68	$111	-39%	39
43239 Egd biopsy single/multiple	$216	$349	-38%	28
88313 Special stains group 2	$44	$71	-38%	28
51702 Insert temp bladder cath	$39	$61	-35%	39
43235 Egd diagnostic brush wash	$191	$294	-35%	28
88312 Special stains group 1	$64	$97	-34%	72
45380 Colonoscopy and biopsy	$311	$470	-34%	28
52332 Cystoscopy and treatment	$242	$360	-33%	39
43255 Egd control bleeding any	$310	$459	-32%	28
45384 Colonoscopy w/lesion removal	$354	$519	-32%	28
52224 Cystoscopy and treatment	$313	$459	-32%	39
64566 Neuroeltrd stim post tibial	$47	$69	-32%	39
45378 Diagnostic colonoscopy	$287	$408	-30%	28

Frequently asked questions

Answers use this page's data

How do commercial reimbursement rates in Montana compare with the rest of the country?

Montana ranks 24th of 51 states with an index of 100, across 228 procedure codes. Median commercial rates run 160% of the Medicare rate.

Which payer has the highest rates in Montana?

In the files we analyzed, Aetna has the highest index (123) and Blue Cross Blue Shield the lowest (100). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.

Which specialty has the strongest rates in Montana?

Ophthalmology ranks 12th of 50 states.

How many providers does this Montana page cover?

448 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.

Which procedures differ most between Montana and the national median?

CPT 93298 (Rem interrog dev eval scrms) is highest relative to the nation at 307% of the national median; CPT 52000 (Cystourethroscopy) is lowest at 60%.

Methodology

How these numbers are calculated

Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.

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