How much rates vary
Facilitymedian $1,000 · 10th to 90th $457 to $4,266Professionalmedian $1,259 · 10th to 90th $871 to $1,549
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 Facility Modifier None Typical Low $1,621.81 Median $4,466.84 Typical High $7,244.36 | Facility | None | $1,621.81 | $4,466.84 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $891.25 Median $1,445.44 Typical High $1,445.44 | Professional | None | $891.25 | $1,445.44 | $1,445.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $676.08 Median $1,071.52 Typical High $1,071.52 | Professional | 54 · Surgery only | $676.08 | $1,071.52 | $1,071.52 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $134.90 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $134.90 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $1,000.00 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $630.96 | $1,000.00 | $1,000.00 |
BCBS Idaho Setting Facility Modifier None Typical Low $616.60 Median $1,318.26 Typical High $4,265.80 | Facility | None | $616.60 | $1,318.26 | $4,265.80 |
BCBS Idaho Setting Professional Modifier None Typical Low $1,148.15 Median $1,380.38 Typical High $1,445.44 | Professional | None | $1,148.15 | $1,380.38 | $1,445.44 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $1,047.13 Median $1,174.90 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,047.13 | $1,174.90 | $1,258.93 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $128.82 Typical High $141.25 | Professional | 55 · Aftercare only | $114.82 | $128.82 | $141.25 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $812.83 Median $912.01 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $812.83 | $912.01 | $977.24 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $912.01 Typical High $1,230.27 | Facility | None | $812.83 | $912.01 | $1,230.27 |
Cigna Setting Professional Modifier None Typical Low $831.76 Median $977.24 Typical High $1,096.48 | Professional | None | $831.76 | $977.24 | $1,096.48 |
Moda Health Setting Facility Modifier None Typical Low $758.58 Median $1,445.44 Typical High $5,495.41 | Facility | None | $758.58 | $1,445.44 | $5,495.41 |
Moda Health Setting Professional Modifier None Typical Low $891.25 Median $1,445.44 Typical High $1,698.24 | Professional | None | $891.25 | $1,445.44 | $1,698.24 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $676.08 Median $1,071.52 Typical High $1,071.52 | Professional | 54 · Surgery only | $676.08 | $1,071.52 | $1,071.52 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $134.90 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $134.90 | $218.78 | $218.78 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $1,000.00 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $630.96 | $1,000.00 | $1,000.00 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $1,023.29 Median $1,258.93 Typical High $1,258.93 | Facility | None | $1,023.29 | $1,258.93 | $1,258.93 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,584.89 | Professional | None | $1,258.93 | $1,258.93 | $1,584.89 |
Regence BlueShield Setting Facility Modifier None Typical Low $2,754.23 Median $3,890.45 Typical High $5,248.07 | Facility | None | $2,754.23 | $3,890.45 | $5,248.07 |
Regence BlueShield Setting Professional Modifier None Typical Low $1,202.26 Median $1,445.44 Typical High $1,698.24 | Professional | None | $1,202.26 | $1,445.44 | $1,698.24 |
Select Health Setting Facility Modifier None Typical Low $602.56 Median $616.60 Typical High $1,479.11 | Facility | None | $602.56 | $616.60 | $1,479.11 |
Select Health Setting Professional Modifier None Typical Low $602.56 Median $707.95 Typical High $1,096.48 | Professional | None | $602.56 | $707.95 | $1,096.48 |
United Setting Facility Modifier None Typical Low $363.08 Median $501.19 Typical High $724.44 | Facility | None | $363.08 | $501.19 | $724.44 |
United Setting Professional Modifier None Typical Low $724.44 Median $1,000.00 Typical High $1,445.44 | Professional | None | $724.44 | $1,000.00 | $1,445.44 |
9 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 $446.68 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $446.68 | $724.44 | $724.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $177.83 Median $288.40 Typical High $288.40 | Professional | 53 · Discontinued | $177.83 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $89.13 Median $144.54 Typical High $144.54 | Professional | 56 · Pre-op care only | $89.13 | $144.54 | $144.54 |
BCBS Idaho Setting Facility Modifier 50 · Both sides Typical Low $912.01 Median $1,905.46 Typical High $6,606.93 | Facility | 50 · Both sides | $912.01 | $1,905.46 | $6,606.93 |
BCBS Idaho Setting Professional Modifier 50 · Both sides Typical Low $1,737.80 Median $1,949.84 Typical High $2,137.96 | Professional | 50 · Both sides | $1,737.80 | $1,949.84 | $2,137.96 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $1,380.38 Median $1,548.82 Typical High $1,698.24 | Professional | 63 · Small infant | $1,380.38 | $1,548.82 | $1,698.24 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $446.68 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $446.68 | $724.44 | $724.44 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $177.83 Median $288.40 Typical High $288.40 | Professional | 53 · Discontinued | $177.83 | $288.40 | $288.40 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $89.13 Median $144.54 Typical High $144.54 | Professional | 56 · Pre-op care only | $89.13 | $144.54 | $144.54 |
Where Idaho sits
The same service costs 3.6 times more in Colorado than in Delaware. 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.
Physician feeFacility fee
CO $4,868DE $1,354
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.