How much rates vary
Facilitymedian $2,344 · 10th to 90th $1,413 to $8,511Professionalmedian $1,349 · 10th to 90th $813 to $1,585
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 $1,122.02 Median $1,659.59 Typical High $5,495.41 | Facility | None | $1,122.02 | $1,659.59 | $5,495.41 |
Aetna Setting Professional Modifier None Typical Low $707.95 Median $1,412.54 Typical High $1,584.89 | Professional | None | $707.95 | $1,412.54 | $1,584.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $660.69 Median $1,047.13 Typical High $1,047.13 | Professional | 54 · Surgery only | $660.69 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $131.83 Median $208.93 Typical High $208.93 | Professional | 55 · Aftercare only | $131.83 | $208.93 | $208.93 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $616.60 Median $977.24 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $616.60 | $977.24 | $977.24 |
BCBS Idaho Setting Facility Modifier None Typical Low $2,187.76 Median $4,265.80 Typical High $8,511.38 | Facility | None | $2,187.76 | $4,265.80 | $8,511.38 |
BCBS Idaho Setting Professional Modifier None Typical Low $1,148.15 Median $1,348.96 Typical High $1,412.54 | Professional | None | $1,148.15 | $1,348.96 | $1,412.54 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,174.90 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,023.29 | $1,174.90 | $1,258.93 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $131.83 Typical High $141.25 | Professional | 55 · Aftercare only | $114.82 | $131.83 | $141.25 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $912.01 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $794.33 | $912.01 | $977.24 |
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 $831.76 Median $954.99 Typical High $1,071.52 | Professional | None | $831.76 | $954.99 | $1,071.52 |
Moda Health Setting Facility Modifier None Typical Low $1,122.02 Median $5,248.07 Typical High $32,359.37 | Facility | None | $1,122.02 | $5,248.07 | $32,359.37 |
Moda Health Setting Professional Modifier None Typical Low $870.96 Median $1,412.54 Typical High $1,659.59 | Professional | None | $870.96 | $1,412.54 | $1,659.59 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $660.69 Median $1,047.13 Typical High $1,047.13 | Professional | 54 · Surgery only | $660.69 | $1,047.13 | $1,047.13 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $131.83 Median $208.93 Typical High $208.93 | Professional | 55 · Aftercare only | $131.83 | $208.93 | $208.93 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $616.60 Median $977.24 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $616.60 | $977.24 | $977.24 |
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 $1,000.00 Median $1,412.54 Typical High $1,412.54 | Facility | None | $1,000.00 | $1,412.54 | $1,412.54 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $1,659.59 | Professional | None | $1,412.54 | $1,412.54 | $1,659.59 |
Regence BlueShield Setting Facility Modifier None Typical Low $5,495.41 Median $7,244.36 Typical High $10,715.19 | Facility | None | $5,495.41 | $7,244.36 | $10,715.19 |
Regence BlueShield Setting Professional Modifier None Typical Low $1,258.93 Median $1,380.38 Typical High $1,659.59 | Professional | None | $1,258.93 | $1,380.38 | $1,659.59 |
Select Health Setting Facility Modifier None Typical Low $588.84 Median $602.56 Typical High $5,011.87 | Facility | None | $588.84 | $602.56 | $5,011.87 |
Select Health Setting Professional Modifier None Typical Low $588.84 Median $691.83 Typical High $1,862.09 | Professional | None | $588.84 | $691.83 | $1,862.09 |
United Setting Facility Modifier None Typical Low $1,412.54 Median $1,819.70 Typical High $3,235.94 | Facility | None | $1,412.54 | $1,819.70 | $3,235.94 |
United Setting Professional Modifier None Typical Low $741.31 Median $1,000.00 Typical High $1,479.11 | Professional | None | $741.31 | $1,000.00 | $1,479.11 |
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 $707.95 Typical High $707.95 | Professional | 52 · Reduced service | $446.68 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $177.83 Median $281.84 Typical High $281.84 | Professional | 53 · Discontinued | $177.83 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $89.13 Median $141.25 Typical High $141.25 | Professional | 56 · Pre-op care only | $89.13 | $141.25 | $141.25 |
BCBS Idaho Setting Facility Modifier 50 · Both sides Typical Low $3,311.31 Median $5,754.40 Typical High $12,589.25 | Facility | 50 · Both sides | $3,311.31 | $5,754.40 | $12,589.25 |
BCBS Idaho Setting Professional Modifier 50 · Both sides Typical Low $1,698.24 Median $1,949.84 Typical High $2,089.30 | Professional | 50 · Both sides | $1,698.24 | $1,949.84 | $2,089.30 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $1,380.38 Median $1,584.89 Typical High $1,698.24 | Professional | 63 · Small infant | $1,380.38 | $1,584.89 | $1,698.24 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $446.68 Median $707.95 Typical High $707.95 | Professional | 52 · Reduced service | $446.68 | $707.95 | $707.95 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $177.83 Median $281.84 Typical High $281.84 | Professional | 53 · Discontinued | $177.83 | $281.84 | $281.84 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $89.13 Median $141.25 Typical High $141.25 | Professional | 56 · Pre-op care only | $89.13 | $141.25 | $141.25 |
Where Idaho sits
The same service costs 3.6 times more in Wisconsin than in Montana. 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 $7,904MT $2,218
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.