How much rates vary
Facilitymedian $76 · 10th to 90th $48 to $123Professionalmedian $55 · 10th to 90th $13 to $79
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 $46.77 Median $46.77 Typical High $54.95 | Professional | None (both parts) | $46.77 | $46.77 | $54.95 |
Aetna Setting Professional Modifier 26 · Professional part Typical Low $19.05 Median $19.05 Typical High $19.50 | Professional | 26 · Professional part | $19.05 | $19.05 | $19.50 |
Aetna Setting Professional Modifier TC · Technical part Typical Low $27.54 Median $27.54 Typical High $35.48 | Professional | TC · Technical part | $27.54 | $27.54 | $35.48 |
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 $45.71 Median $79.43 Typical High $79.43 | Professional | None (both parts) | $45.71 | $79.43 | $79.43 |
BCBS Idaho Setting Professional Modifier 26 · Professional part Typical Low $18.20 Median $30.20 Typical High $30.20 | Professional | 26 · Professional part | $18.20 | $30.20 | $30.20 |
BCBS Idaho Setting Professional Modifier TC · Technical part Typical Low $27.54 Median $50.12 Typical High $50.12 | Professional | TC · Technical part | $27.54 | $50.12 | $50.12 |
Moda Health Setting Facility Modifier None Typical Low $46.77 Median $54.95 Typical High $5,495.41 | Facility | None | $46.77 | $54.95 | $5,495.41 |
Moda Health Setting Professional Modifier None (both parts) Typical Low $46.77 Median $46.77 Typical High $54.95 | Professional | None (both parts) | $46.77 | $46.77 | $54.95 |
Moda Health Setting Professional Modifier 26 · Professional part Typical Low $19.05 Median $19.05 Typical High $19.50 | Professional | 26 · Professional part | $19.05 | $19.05 | $19.50 |
Moda Health Setting Professional Modifier TC · Technical part Typical Low $27.54 Median $27.54 Typical High $35.48 | Professional | TC · Technical part | $27.54 | $27.54 | $35.48 |
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 $89.13 Median $89.13 Typical High $89.13 | Facility | None | $89.13 | $89.13 | $89.13 |
MountainHealth Co-op Setting Professional Modifier None (both parts) Typical Low $13.18 Median $13.18 Typical High $13.18 | Professional | None (both parts) | $13.18 | $13.18 | $13.18 |
MountainHealth Co-op Setting Professional Modifier 26 · Professional part Typical Low $26.30 Median $26.30 Typical High $26.30 | Professional | 26 · Professional part | $26.30 | $26.30 | $26.30 |
MountainHealth Co-op Setting Professional Modifier TC · Technical part Typical Low $38.90 Median $38.90 Typical High $38.90 | Professional | TC · Technical part | $38.90 | $38.90 | $38.90 |
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 $79.43 Median $79.43 Typical High $79.43 | Professional | None (both parts) | $79.43 | $79.43 | $79.43 |
Regence BlueShield Setting Professional Modifier 26 · Professional part Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | 26 · Professional part | $30.20 | $30.20 | $30.20 |
Regence BlueShield Setting Professional Modifier TC · Technical part Typical Low $50.12 Median $50.12 Typical High $50.12 | Professional | TC · Technical part | $50.12 | $50.12 | $50.12 |
Select Health Setting Facility Modifier None Typical Low $47.86 Median $47.86 Typical High $48.98 | Facility | None | $47.86 | $47.86 | $48.98 |
Select Health Setting Professional Modifier None (both parts) Typical Low $47.86 Median $47.86 Typical High $75.86 | Professional | None (both parts) | $47.86 | $47.86 | $75.86 |
United Setting Professional Modifier None (both parts) Typical Low $53.70 Median $72.44 Typical High $95.50 | Professional | None (both parts) | $53.70 | $72.44 | $95.50 |
United Setting Professional Modifier 26 · Professional part Typical Low $20.42 Median $27.54 Typical High $36.31 | Professional | 26 · Professional part | $20.42 | $27.54 | $36.31 |
United Setting Professional Modifier TC · Technical part Typical Low $33.11 Median $44.67 Typical High $58.88 | Professional | TC · Technical part | $33.11 | $44.67 | $58.88 |
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 $23.44 Median $23.44 Typical High $27.54 | Professional | 52 · Reduced service | $23.44 | $23.44 | $27.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $9.33 Typical High $10.96 | Professional | 53 · Discontinued | $9.33 | $9.33 | $10.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $34.67 Median $34.67 Typical High $40.74 | Professional | 54 · Surgery only | $34.67 | $34.67 | $40.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.92 Median $6.92 Typical High $8.13 | Professional | 55 · Aftercare only | $6.92 | $6.92 | $8.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $4.68 Typical High $5.50 | Professional | 56 · Pre-op care only | $4.68 | $4.68 | $5.50 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $28.84 Median $33.88 Typical High $33.88 | Professional | 78 · Unplanned return to OR | $28.84 | $33.88 | $33.88 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $23.44 Median $23.44 Typical High $27.54 | Professional | 52 · Reduced service | $23.44 | $23.44 | $27.54 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $9.33 Typical High $10.96 | Professional | 53 · Discontinued | $9.33 | $9.33 | $10.96 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $34.67 Median $34.67 Typical High $40.74 | Professional | 54 · Surgery only | $34.67 | $34.67 | $40.74 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $6.92 Median $6.92 Typical High $8.13 | Professional | 55 · Aftercare only | $6.92 | $6.92 | $8.13 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $4.68 Typical High $5.50 | Professional | 56 · Pre-op care only | $4.68 | $4.68 | $5.50 |
Where Idaho sits
The same service costs 3.3 times more in Nebraska 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· 24th of 51
$57.54
NE $112NY $33.88
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.