How much rates vary
Facilitymedian $85 · 10th to 90th $65 to $123Professionalmedian $81 · 10th to 90th $17 to $110
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 Facility Modifier None Typical Low $4,466.84 Median $4,466.84 Typical High $5,495.41 | Facility | None | $4,466.84 | $4,466.84 | $5,495.41 |
Aetna Setting Professional Modifier None (both parts) Typical Low $69.18 Median $69.18 Typical High $81.28 | Professional | None (both parts) | $69.18 | $69.18 | $81.28 |
Aetna Setting Professional Modifier 26 · Professional part Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | 26 · Professional part | $28.18 | $28.18 | $28.18 |
Aetna Setting Professional Modifier TC · Technical part Typical Low $40.74 Median $40.74 Typical High $52.48 | Professional | TC · Technical part | $40.74 | $40.74 | $52.48 |
BCBS Idaho Setting Facility Modifier None Typical Low $61.66 Median $85.11 Typical High $123.03 | Facility | None | $61.66 | $85.11 | $123.03 |
BCBS Idaho Setting Professional Modifier None (both parts) Typical Low $61.66 Median $109.65 Typical High $109.65 | Professional | None (both parts) | $61.66 | $109.65 | $109.65 |
BCBS Idaho Setting Professional Modifier 26 · Professional part Typical Low $28.84 Median $41.69 Typical High $41.69 | Professional | 26 · Professional part | $28.84 | $41.69 | $41.69 |
BCBS Idaho Setting Professional Modifier TC · Technical part Typical Low $32.36 Median $69.18 Typical High $69.18 | Professional | TC · Technical part | $32.36 | $69.18 | $69.18 |
Moda Health Setting Facility Modifier None Typical Low $69.18 Median $81.28 Typical High $5,495.41 | Facility | None | $69.18 | $81.28 | $5,495.41 |
Moda Health Setting Professional Modifier None (both parts) Typical Low $69.18 Median $69.18 Typical High $81.28 | Professional | None (both parts) | $69.18 | $69.18 | $81.28 |
Moda Health Setting Professional Modifier 26 · Professional part Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | 26 · Professional part | $28.18 | $28.18 | $28.18 |
Moda Health Setting Professional Modifier TC · Technical part Typical Low $40.74 Median $40.74 Typical High $52.48 | Professional | TC · Technical part | $40.74 | $40.74 | $52.48 |
Molina Setting Professional Modifier None (both parts) Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | None (both parts) | $30.20 | $30.20 | $30.20 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $117.49 Median $117.49 Typical High $117.49 | Facility | None | $117.49 | $117.49 | $117.49 |
MountainHealth Co-op Setting Professional Modifier None (both parts) Typical Low $17.38 Median $17.38 Typical High $17.38 | Professional | None (both parts) | $17.38 | $17.38 | $17.38 |
MountainHealth Co-op Setting Professional Modifier 26 · Professional part Typical Low $33.88 Median $33.88 Typical High $33.88 | Professional | 26 · Professional part | $33.88 | $33.88 | $33.88 |
MountainHealth Co-op Setting Professional Modifier TC · Technical part Typical Low $52.48 Median $52.48 Typical High $52.48 | Professional | TC · Technical part | $52.48 | $52.48 | $52.48 |
Regence BlueShield Setting Facility Modifier None Typical Low $70.79 Median $97.72 Typical High $123.03 | Facility | None | $70.79 | $97.72 | $123.03 |
Regence BlueShield Setting Professional Modifier None (both parts) Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | None (both parts) | $109.65 | $109.65 | $109.65 |
Regence BlueShield Setting Professional Modifier 26 · Professional part Typical Low $41.69 Median $41.69 Typical High $41.69 | Professional | 26 · Professional part | $41.69 | $41.69 | $41.69 |
Regence BlueShield Setting Professional Modifier TC · Technical part Typical Low $69.18 Median $69.18 Typical High $69.18 | Professional | TC · Technical part | $69.18 | $69.18 | $69.18 |
Select Health Setting Facility Modifier None Typical Low $64.57 Median $64.57 Typical High $67.61 | Facility | None | $64.57 | $64.57 | $67.61 |
Select Health Setting Professional Modifier None (both parts) Typical Low $39.81 Median $64.57 Typical High $91.20 | Professional | None (both parts) | $39.81 | $64.57 | $91.20 |
United Setting Professional Modifier None (both parts) Typical Low $79.43 Median $107.15 Typical High $138.04 | Professional | None (both parts) | $79.43 | $107.15 | $138.04 |
United Setting Professional Modifier 26 · Professional part Typical Low $30.20 Median $40.74 Typical High $53.70 | Professional | 26 · Professional part | $30.20 | $40.74 | $53.70 |
United Setting Professional Modifier TC · Technical part Typical Low $47.86 Median $64.57 Typical High $87.10 | Professional | TC · Technical part | $47.86 | $64.57 | $87.10 |
11 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 $34.67 Median $34.67 Typical High $39.81 | Professional | 52 · Reduced service | $34.67 | $34.67 | $39.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.80 Median $13.80 Typical High $16.22 | Professional | 53 · Discontinued | $13.80 | $13.80 | $16.22 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $51.29 Median $51.29 Typical High $60.26 | Professional | 54 · Surgery only | $51.29 | $51.29 | $60.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.23 Median $10.23 Typical High $12.02 | Professional | 55 · Aftercare only | $10.23 | $10.23 | $12.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.92 Median $6.92 Typical High $7.94 | Professional | 56 · Pre-op care only | $6.92 | $6.92 | $7.94 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $38.02 Median $44.67 Typical High $44.67 | Professional | 78 · Unplanned return to OR | $38.02 | $44.67 | $44.67 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $34.67 Median $34.67 Typical High $39.81 | Professional | 52 · Reduced service | $34.67 | $34.67 | $39.81 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $13.80 Median $13.80 Typical High $16.22 | Professional | 53 · Discontinued | $13.80 | $13.80 | $16.22 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $51.29 Median $51.29 Typical High $60.26 | Professional | 54 · Surgery only | $51.29 | $51.29 | $60.26 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $10.23 Median $10.23 Typical High $12.02 | Professional | 55 · Aftercare only | $10.23 | $10.23 | $12.02 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $6.92 Median $6.92 Typical High $8.13 | Professional | 56 · Pre-op care only | $6.92 | $6.92 | $8.13 |
Where Idaho sits
The same service costs 4.4 times more in Texas than in New York. 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.
Idaho· 22nd of 51
$81.28
TX $174NY $39.81
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.