How much rates vary
Facilitymedian $2,239 · 10th to 90th $1,175 to $7,762Professionalmedian $1,175 · 10th to 90th $776 to $1,445
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 $676.08 Median $1,348.96 Typical High $1,348.96 | Professional | None | $676.08 | $1,348.96 | $1,348.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $630.96 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $125.89 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $588.84 | $933.25 | $933.25 |
BCBS Idaho Setting Facility Modifier None Typical Low $2,187.76 Median $3,715.35 Typical High $8,511.38 | Facility | None | $2,187.76 | $3,715.35 | $8,511.38 |
BCBS Idaho Setting Professional Modifier None Typical Low $1,096.48 Median $1,288.25 Typical High $1,318.26 | Professional | None | $1,096.48 | $1,288.25 | $1,318.26 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $977.24 Median $1,096.48 Typical High $1,202.26 | Professional | 54 · Surgery only | $977.24 | $1,096.48 | $1,202.26 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $123.03 Typical High $131.83 | Professional | 55 · Aftercare only | $109.65 | $123.03 | $131.83 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $851.14 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $758.58 | $851.14 | $933.25 |
Cigna Setting Facility Modifier None Typical Low $1,819.70 Median $2,041.74 Typical High $2,754.23 | Facility | None | $1,819.70 | $2,041.74 | $2,754.23 |
Cigna Setting Professional Modifier None Typical Low $794.33 Median $912.01 Typical High $1,023.29 | Professional | None | $794.33 | $912.01 | $1,023.29 |
Moda Health Setting Facility Modifier None Typical Low $831.76 Median $5,128.61 Typical High $6,760.83 | Facility | None | $831.76 | $5,128.61 | $6,760.83 |
Moda Health Setting Professional Modifier None Typical Low $831.76 Median $1,348.96 Typical High $1,584.89 | Professional | None | $831.76 | $1,348.96 | $1,584.89 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $630.96 | $1,000.00 | $1,000.00 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $125.89 | $199.53 | $199.53 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $588.84 | $933.25 | $933.25 |
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 $954.99 Median $1,174.90 Typical High $1,174.90 | Facility | None | $954.99 | $1,174.90 | $1,174.90 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,479.11 | Professional | None | $1,174.90 | $1,174.90 | $1,479.11 |
Regence BlueShield Setting Facility Modifier None Typical Low $5,495.41 Median $7,762.47 Typical High $10,715.19 | Facility | None | $5,495.41 | $7,762.47 | $10,715.19 |
Regence BlueShield Setting Professional Modifier None Typical Low $1,202.26 Median $1,318.26 Typical High $1,584.89 | Professional | None | $1,202.26 | $1,318.26 | $1,584.89 |
Select Health Setting Facility Modifier None Typical Low $562.34 Median $575.44 Typical High $5,248.07 | Facility | None | $562.34 | $575.44 | $5,248.07 |
Select Health Setting Professional Modifier None Typical Low $562.34 Median $660.69 Typical High $1,862.09 | Professional | None | $562.34 | $660.69 | $1,862.09 |
United Setting Facility Modifier None Typical Low $1,412.54 Median $1,819.70 Typical High $2,398.83 | Facility | None | $1,412.54 | $1,819.70 | $2,398.83 |
United Setting Professional Modifier None Typical Low $724.44 Median $977.24 Typical High $1,412.54 | Professional | None | $724.44 | $977.24 | $1,412.54 |
10 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 $416.87 Median $676.08 Typical High $676.08 | Professional | 52 · Reduced service | $416.87 | $676.08 | $676.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $165.96 Median $269.15 Typical High $269.15 | Professional | 53 · Discontinued | $165.96 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $134.90 Typical High $134.90 | Professional | 56 · Pre-op care only | $83.18 | $134.90 | $134.90 |
BCBS Idaho Setting Facility Modifier 50 · Both sides Typical Low $3,311.31 Median $5,370.32 Typical High $12,589.25 | Facility | 50 · Both sides | $3,311.31 | $5,370.32 | $12,589.25 |
BCBS Idaho Setting Professional Modifier 50 · Both sides Typical Low $1,621.81 Median $1,819.70 Typical High $1,995.26 | Professional | 50 · Both sides | $1,621.81 | $1,819.70 | $1,995.26 |
BCBS Idaho Setting Professional Modifier 62 · Two surgeons Typical Low $676.08 Median $758.58 Typical High $831.76 | Professional | 62 · Two surgeons | $676.08 | $758.58 | $831.76 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $1,318.26 Median $1,479.11 Typical High $1,584.89 | Professional | 63 · Small infant | $1,318.26 | $1,479.11 | $1,584.89 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $416.87 Median $676.08 Typical High $676.08 | Professional | 52 · Reduced service | $416.87 | $676.08 | $676.08 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $165.96 Median $269.15 Typical High $269.15 | Professional | 53 · Discontinued | $165.96 | $269.15 | $269.15 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $134.90 Typical High $134.90 | Professional | 56 · Pre-op care only | $83.18 | $134.90 | $134.90 |
Where Idaho sits
The same service costs 3.5 times more in Wisconsin than in Hawaii. 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
WI $7,283HI $2,091
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.