How much rates vary
Facilitymedian $4,898 · 10th to 90th $2,089 to $16,218Professionalmedian $1,995 · 10th to 90th $1,259 to $2,399
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 $1,513.56 Median $2,884.03 Typical High $7,762.47 | Facility | None | $1,513.56 | $2,884.03 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $1,047.13 Median $2,089.30 Typical High $2,398.83 | Professional | None | $1,047.13 | $2,089.30 | $2,398.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,000.00 | $1,584.89 | $1,584.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $316.23 Typical High $316.23 | Professional | 55 · Aftercare only | $199.53 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $933.25 | $1,479.11 | $1,479.11 |
BCBS Idaho Setting Facility Modifier None Typical Low $4,365.16 Median $6,918.31 Typical High $18,620.87 | Facility | None | $4,365.16 | $6,918.31 | $18,620.87 |
BCBS Idaho Setting Professional Modifier None Typical Low $1,698.24 Median $1,995.26 Typical High $2,089.30 | Professional | None | $1,698.24 | $1,995.26 | $2,089.30 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $1,513.56 Median $1,737.80 Typical High $1,905.46 | Professional | 54 · Surgery only | $1,513.56 | $1,737.80 | $1,905.46 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $194.98 Typical High $208.93 | Professional | 55 · Aftercare only | $169.82 | $194.98 | $208.93 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $1,348.96 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,174.90 | $1,348.96 | $1,479.11 |
Cigna Setting Facility Modifier None Typical Low $4,073.80 Median $4,570.88 Typical High $6,165.95 | Facility | None | $4,073.80 | $4,570.88 | $6,165.95 |
Cigna Setting Professional Modifier None Typical Low $1,230.27 Median $1,412.54 Typical High $1,621.81 | Professional | None | $1,230.27 | $1,412.54 | $1,621.81 |
Moda Health Setting Facility Modifier None Typical Low $1,318.26 Median $3,019.95 Typical High $13,803.84 | Facility | None | $1,318.26 | $3,019.95 | $13,803.84 |
Moda Health Setting Professional Modifier None Typical Low $1,318.26 Median $2,089.30 Typical High $2,454.71 | Professional | None | $1,318.26 | $2,089.30 | $2,454.71 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,000.00 | $1,584.89 | $1,584.89 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $316.23 Typical High $316.23 | Professional | 55 · Aftercare only | $199.53 | $316.23 | $316.23 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $933.25 | $1,479.11 | $1,479.11 |
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 $1,479.11 Median $2,089.30 Typical High $2,089.30 | Facility | None | $1,479.11 | $2,089.30 | $2,089.30 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,454.71 | Professional | None | $2,089.30 | $2,089.30 | $2,454.71 |
Regence BlueShield Setting Facility Modifier None Typical Low $11,220.18 Median $16,218.10 Typical High $23,442.29 | Facility | None | $11,220.18 | $16,218.10 | $23,442.29 |
Regence BlueShield Setting Professional Modifier None Typical Low $1,862.09 Median $2,089.30 Typical High $2,454.71 | Professional | None | $1,862.09 | $2,089.30 | $2,454.71 |
Select Health Setting Facility Modifier None Typical Low $870.96 Median $891.25 Typical High $10,232.93 | Facility | None | $870.96 | $891.25 | $10,232.93 |
Select Health Setting Professional Modifier None Typical Low $870.96 Median $1,023.29 Typical High $4,168.69 | Professional | None | $870.96 | $1,023.29 | $4,168.69 |
United Setting Facility Modifier None Typical Low $1,288.25 Median $2,818.38 Typical High $5,011.87 | Facility | None | $1,288.25 | $2,818.38 | $5,011.87 |
United Setting Professional Modifier None Typical Low $1,096.48 Median $1,479.11 Typical High $2,187.76 | Professional | None | $1,096.48 | $1,479.11 | $2,187.76 |
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 $660.69 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $660.69 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $416.87 Typical High $416.87 | Professional | 53 · Discontinued | $263.03 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $131.83 | $208.93 | $208.93 |
BCBS Idaho Setting Facility Modifier 50 · Both sides Typical Low $6,606.93 Median $9,772.37 Typical High $28,183.83 | Facility | 50 · Both sides | $6,606.93 | $9,772.37 | $28,183.83 |
BCBS Idaho Setting Professional Modifier 50 · Both sides Typical Low $2,511.89 Median $2,951.21 Typical High $3,162.28 | Professional | 50 · Both sides | $2,511.89 | $2,951.21 | $3,162.28 |
BCBS Idaho Setting Professional Modifier 62 · Two surgeons Typical Low $1,047.13 Median $1,202.26 Typical High $1,318.26 | Professional | 62 · Two surgeons | $1,047.13 | $1,202.26 | $1,318.26 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $2,041.74 Median $2,344.23 Typical High $2,511.89 | Professional | 63 · Small infant | $2,041.74 | $2,344.23 | $2,511.89 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $660.69 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $660.69 | $1,047.13 | $1,047.13 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $416.87 Typical High $416.87 | Professional | 53 · Discontinued | $263.03 | $416.87 | $416.87 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $131.83 | $208.93 | $208.93 |
Where Idaho sits
The same service costs 6.2 times more in Vermont 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
VT $19,228HI $3,097
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.