How much rates vary
Facilitymedian $912 · 10th to 90th $575 to $3,715Professionalmedian $794 · 10th to 90th $468 to $1,230
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 $1,412.54 Median $4,466.84 Typical High $7,079.46 | Facility | None | $1,412.54 | $4,466.84 | $7,079.46 |
Aetna Setting Professional Modifier None Typical Low $489.78 Median $1,230.27 Typical High $1,230.27 | Professional | None | $489.78 | $1,230.27 | $1,230.27 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $363.08 Median $933.25 Typical High $933.25 | Professional | 54 · Surgery only | $363.08 | $933.25 | $933.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $72.44 Median $186.21 Typical High $186.21 | Professional | 55 · Aftercare only | $72.44 | $186.21 | $186.21 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $338.84 Median $870.96 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $338.84 | $870.96 | $870.96 |
BCBS Idaho Setting Facility Modifier None Typical Low $891.25 Median $1,862.09 Typical High $3,548.13 | Facility | None | $891.25 | $1,862.09 | $3,548.13 |
BCBS Idaho Setting Professional Modifier None Typical Low $741.31 Median $851.14 Typical High $891.25 | Professional | None | $741.31 | $851.14 | $891.25 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $660.69 Median $758.58 Typical High $794.33 | Professional | 54 · Surgery only | $660.69 | $758.58 | $794.33 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $74.13 Median $83.18 Typical High $89.13 | Professional | 55 · Aftercare only | $74.13 | $83.18 | $89.13 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $588.84 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $512.86 | $588.84 | $630.96 |
Cigna Setting Facility Modifier None Typical Low $724.44 Median $812.83 Typical High $1,096.48 | Facility | None | $724.44 | $812.83 | $1,096.48 |
Cigna Setting Professional Modifier None Typical Low $501.19 Median $602.56 Typical High $707.95 | Professional | None | $501.19 | $602.56 | $707.95 |
Moda Health Setting Facility Modifier None Typical Low $380.19 Median $1,230.27 Typical High $5,495.41 | Facility | None | $380.19 | $1,230.27 | $5,495.41 |
Moda Health Setting Professional Modifier None Typical Low $588.84 Median $812.83 Typical High $1,230.27 | Professional | None | $588.84 | $812.83 | $1,230.27 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $446.68 Median $933.25 Typical High $933.25 | Professional | 54 · Surgery only | $446.68 | $933.25 | $933.25 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $89.13 Median $186.21 Typical High $186.21 | Professional | 55 · Aftercare only | $89.13 | $186.21 | $186.21 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $416.87 Median $870.96 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $416.87 | $870.96 | $870.96 |
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 $645.65 Median $794.33 Typical High $794.33 | Facility | None | $645.65 | $794.33 | $794.33 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $794.33 Median $794.33 Typical High $831.76 | Professional | None | $794.33 | $794.33 | $831.76 |
MountainHealth Co-op Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $588.84 Typical High $588.84 | Professional | 54 · Surgery only | $588.84 | $588.84 | $588.84 |
MountainHealth Co-op Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $630.96 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $630.96 | $630.96 | $630.96 |
Regence BlueShield Setting Facility Modifier None Typical Low $1,995.26 Median $2,884.03 Typical High $3,890.45 | Facility | None | $1,995.26 | $2,884.03 | $3,890.45 |
Regence BlueShield Setting Professional Modifier None Typical Low $741.31 Median $870.96 Typical High $870.96 | Professional | None | $741.31 | $870.96 | $870.96 |
Select Health Setting Facility Modifier None Typical Low $380.19 Median $389.05 Typical High $4,570.88 | Facility | None | $380.19 | $389.05 | $4,570.88 |
Select Health Setting Professional Modifier None Typical Low $380.19 Median $380.19 Typical High $812.83 | Professional | None | $380.19 | $380.19 | $812.83 |
United Setting Facility Modifier None Typical Low $549.54 Median $676.08 Typical High $954.99 | Facility | None | $549.54 | $676.08 | $954.99 |
United Setting Professional Modifier None Typical Low $446.68 Median $588.84 Typical High $891.25 | Professional | None | $446.68 | $588.84 | $891.25 |
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 $239.88 Median $616.60 Typical High $616.60 | Professional | 52 · Reduced service | $239.88 | $616.60 | $616.60 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $95.50 Median $251.19 Typical High $251.19 | Professional | 53 · Discontinued | $95.50 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $47.86 Median $123.03 Typical High $123.03 | Professional | 56 · Pre-op care only | $47.86 | $123.03 | $123.03 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $891.25 Median $1,000.00 Typical High $1,071.52 | Professional | 63 · Small infant | $891.25 | $1,000.00 | $1,071.52 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $295.12 Median $616.60 Typical High $616.60 | Professional | 52 · Reduced service | $295.12 | $616.60 | $616.60 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $117.49 Median $251.19 Typical High $251.19 | Professional | 53 · Discontinued | $117.49 | $251.19 | $251.19 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $58.88 Median $123.03 Typical High $123.03 | Professional | 56 · Pre-op care only | $58.88 | $123.03 | $123.03 |
MountainHealth Co-op Setting Professional Modifier 22 · Increased work Typical Low $912.01 Median $912.01 Typical High $912.01 | Professional | 22 · Increased work | $912.01 | $912.01 | $912.01 |
MountainHealth Co-op Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | 56 · Pre-op care only | $83.18 | $83.18 | $83.18 |
MountainHealth Co-op Setting Professional Modifier 63 · Small infant Typical Low $912.01 Median $912.01 Typical High $912.01 | Professional | 63 · Small infant | $912.01 | $912.01 | $912.01 |
Where Idaho sits
The same service costs 6.1 times more in Vermont than in Maryland. 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 $6,769MD $1,107
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.