How much rates vary
Facilitymedian $1,175 · 10th to 90th $550 to $4,467Professionalmedian $2,455 · 10th to 90th $1,514 to $3,311
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 $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 Typical Low $1,380.38 Median $1,995.26 Typical High $3,311.31 | Professional | None | $1,380.38 | $1,995.26 | $3,311.31 |
BCBS Idaho Setting Facility Modifier None Typical Low $3,630.78 Median $3,890.45 Typical High $4,897.79 | Facility | None | $3,630.78 | $3,890.45 | $4,897.79 |
BCBS Idaho Setting Professional Modifier None Typical Low $2,290.87 Median $2,691.53 Typical High $2,818.38 | Professional | None | $2,290.87 | $2,691.53 | $2,818.38 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $1,380.38 Typical High $12,589.25 | Facility | None | $151.36 | $1,380.38 | $12,589.25 |
Cigna Setting Professional Modifier None Typical Low $1,698.24 Median $1,949.84 Typical High $2,344.23 | Professional | None | $1,698.24 | $1,949.84 | $2,344.23 |
Moda Health Setting Facility Modifier None Typical Low $1,174.90 Median $3,311.31 Typical High $5,495.41 | Facility | None | $1,174.90 | $3,311.31 | $5,495.41 |
Moda Health Setting Professional Modifier None Typical Low $1,584.89 Median $2,570.40 Typical High $3,311.31 | Professional | None | $1,584.89 | $2,570.40 | $3,311.31 |
Molina Setting Professional Modifier None Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | None | $30.20 | $30.20 | $30.20 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $2,041.74 Median $2,511.89 Typical High $2,511.89 | Facility | None | $2,041.74 | $2,511.89 | $2,511.89 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $2,511.89 | Professional | None | $2,511.89 | $2,511.89 | $2,511.89 |
Regence BlueShield Setting Professional Modifier None Typical Low $2,344.23 Median $2,754.23 Typical High $2,818.38 | Professional | None | $2,344.23 | $2,754.23 | $2,818.38 |
Select Health Setting Facility Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,288.25 | Facility | None | $1,174.90 | $1,174.90 | $1,288.25 |
Select Health Setting Professional Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,698.24 | Professional | None | $1,174.90 | $1,174.90 | $1,698.24 |
United Setting Facility Modifier None Typical Low $436.52 Median $676.08 Typical High $870.96 | Facility | None | $436.52 | $676.08 | $870.96 |
United Setting Professional Modifier None Typical Low $1,380.38 Median $2,089.30 Typical High $3,019.95 | Professional | None | $1,380.38 | $2,089.30 | $3,019.95 |
21 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 $794.33 Median $1,659.59 Typical High $1,659.59 | Professional | 52 · Reduced service | $794.33 | $1,659.59 | $1,659.59 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $660.69 Typical High $660.69 | Professional | 53 · Discontinued | $316.23 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $2,454.71 Typical High $2,454.71 | Professional | 54 · Surgery only | $1,174.90 | $2,454.71 | $2,454.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $501.19 Typical High $501.19 | Professional | 55 · Aftercare only | $234.42 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $331.13 Typical High $331.13 | Professional | 56 · Pre-op care only | $158.49 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $2,290.87 Typical High $2,290.87 | Professional | 78 · Unplanned return to OR | $1,096.48 | $2,290.87 | $2,290.87 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $1,995.26 Median $2,238.72 Typical High $2,511.89 | Professional | 54 · Surgery only | $1,995.26 | $2,238.72 | $2,511.89 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $251.19 Typical High $281.84 | Professional | 55 · Aftercare only | $223.87 | $251.19 | $281.84 |
BCBS Idaho Setting Professional Modifier 62 · Two surgeons Typical Low $1,412.54 Median $1,548.82 Typical High $1,737.80 | Professional | 62 · Two surgeons | $1,412.54 | $1,548.82 | $1,737.80 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $2,691.53 Median $3,019.95 Typical High $3,388.44 | Professional | 63 · Small infant | $2,691.53 | $3,019.95 | $3,388.44 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,584.89 Median $1,737.80 Typical High $1,949.84 | Professional | 78 · Unplanned return to OR | $1,584.89 | $1,737.80 | $1,949.84 |
BCBS Idaho Setting Professional Modifier 80 · Assistant surgeon Typical Low $354.81 Median $398.11 Typical High $446.68 | Professional | 80 · Assistant surgeon | $354.81 | $398.11 | $446.68 |
BCBS Idaho Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $354.81 Median $398.11 Typical High $446.68 | Professional | 81 · Minimal assistant surgeon | $354.81 | $398.11 | $446.68 |
BCBS Idaho Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $354.81 Median $398.11 Typical High $446.68 | Professional | 82 · Assistant surgeon, no resident | $354.81 | $398.11 | $446.68 |
BCBS Idaho Setting Professional Modifier AS · PA/NP assist Typical Low $302.00 Median $338.84 Typical High $380.19 | Professional | AS · PA/NP assist | $302.00 | $338.84 | $380.19 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $912.01 Median $1,659.59 Typical High $1,659.59 | Professional | 52 · Reduced service | $912.01 | $1,659.59 | $1,659.59 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $371.54 Median $660.69 Typical High $660.69 | Professional | 53 · Discontinued | $371.54 | $660.69 | $660.69 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $1,380.38 Median $2,454.71 Typical High $2,454.71 | Professional | 54 · Surgery only | $1,380.38 | $2,454.71 | $2,454.71 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $275.42 Median $501.19 Typical High $501.19 | Professional | 55 · Aftercare only | $275.42 | $501.19 | $501.19 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $186.21 Median $331.13 Typical High $331.13 | Professional | 56 · Pre-op care only | $186.21 | $331.13 | $331.13 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,288.25 Median $2,290.87 Typical High $2,290.87 | Professional | 78 · Unplanned return to OR | $1,288.25 | $2,290.87 | $2,290.87 |
Where Idaho sits
The same service costs 13.5 times more in Maine than in Washington. 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
ME $28,253WA $2,096
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.