How much rates vary
Facilitymedian $2,344 · 10th to 90th $1,072 to $8,913Professionalmedian $1,096 · 10th to 90th $646 to $1,698
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 $3,388.44 Median $4,466.84 Typical High $8,709.64 | Facility | None | $3,388.44 | $4,466.84 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $630.96 Median $1,698.24 Typical High $1,698.24 | Professional | None | $630.96 | $1,698.24 | $1,698.24 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $501.19 Median $1,288.25 Typical High $1,288.25 | Professional | 54 · Surgery only | $501.19 | $1,288.25 | $1,288.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $100.00 Median $257.04 Typical High $257.04 | Professional | 55 · Aftercare only | $100.00 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $467.74 Median $1,202.26 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $467.74 | $1,202.26 | $1,202.26 |
BCBS Idaho Setting Facility Modifier None Typical Low $1,819.70 Median $3,548.13 Typical High $8,912.51 | Facility | None | $1,819.70 | $3,548.13 | $8,912.51 |
BCBS Idaho Setting Professional Modifier None Typical Low $1,000.00 Median $1,148.15 Typical High $1,202.26 | Professional | None | $1,000.00 | $1,148.15 | $1,202.26 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $891.25 Median $1,023.29 Typical High $1,096.48 | Professional | 54 · Surgery only | $891.25 | $1,023.29 | $1,096.48 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $100.00 Median $114.82 Typical High $120.23 | Professional | 55 · Aftercare only | $100.00 | $114.82 | $120.23 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $794.33 Typical High $851.14 | Professional | 78 · Unplanned return to OR | $691.83 | $794.33 | $851.14 |
Cigna Setting Facility Modifier None Typical Low $1,905.46 Median $2,137.96 Typical High $2,951.21 | Facility | None | $1,905.46 | $2,137.96 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $707.95 Median $831.76 Typical High $977.24 | Professional | None | $707.95 | $831.76 | $977.24 |
Moda Health Setting Facility Modifier None Typical Low $588.84 Median $2,454.71 Typical High $6,918.31 | Facility | None | $588.84 | $2,454.71 | $6,918.31 |
Moda Health Setting Professional Modifier None Typical Low $812.83 Median $1,122.02 Typical High $1,698.24 | Professional | None | $812.83 | $1,122.02 | $1,698.24 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $1,288.25 Typical High $1,288.25 | Professional | 54 · Surgery only | $602.56 | $1,288.25 | $1,288.25 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $257.04 Typical High $257.04 | Professional | 55 · Aftercare only | $120.23 | $257.04 | $257.04 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $1,202.26 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $562.34 | $1,202.26 | $1,202.26 |
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 $870.96 Median $1,071.52 Typical High $1,071.52 | Facility | None | $870.96 | $1,071.52 | $1,071.52 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1,071.52 Median $1,071.52 Typical High $1,148.15 | Professional | None | $1,071.52 | $1,071.52 | $1,148.15 |
MountainHealth Co-op Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $794.33 Typical High $794.33 | Professional | 54 · Surgery only | $794.33 | $794.33 | $794.33 |
MountainHealth Co-op Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $851.14 Typical High $851.14 | Professional | 78 · Unplanned return to OR | $851.14 | $851.14 | $851.14 |
Regence BlueShield Setting Facility Modifier None Typical Low $6,165.95 Median $8,912.51 Typical High $11,220.18 | Facility | None | $6,165.95 | $8,912.51 | $11,220.18 |
Regence BlueShield Setting Professional Modifier None Typical Low $1,023.29 Median $1,202.26 Typical High $1,202.26 | Professional | None | $1,023.29 | $1,202.26 | $1,202.26 |
Select Health Setting Facility Modifier None Typical Low $512.86 Median $524.81 Typical High $7,079.46 | Facility | None | $512.86 | $524.81 | $7,079.46 |
Select Health Setting Professional Modifier None Typical Low $512.86 Median $512.86 Typical High $1,096.48 | Professional | None | $512.86 | $512.86 | $1,096.48 |
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 $630.96 Median $812.83 Typical High $1,230.27 | Professional | None | $630.96 | $812.83 | $1,230.27 |
12 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 $331.13 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $331.13 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $131.83 Median $338.84 Typical High $338.84 | Professional | 53 · Discontinued | $131.83 | $338.84 | $338.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $66.07 Median $169.82 Typical High $169.82 | Professional | 56 · Pre-op care only | $66.07 | $169.82 | $169.82 |
BCBS Idaho Setting Professional Modifier 62 · Two surgeons Typical Low $616.60 Median $707.95 Typical High $758.58 | Professional | 62 · Two surgeons | $616.60 | $707.95 | $758.58 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $1,202.26 Median $1,380.38 Typical High $1,445.44 | Professional | 63 · Small infant | $1,202.26 | $1,380.38 | $1,445.44 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $407.38 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $407.38 | $851.14 | $851.14 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $162.18 Median $338.84 Typical High $338.84 | Professional | 53 · Discontinued | $162.18 | $338.84 | $338.84 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $169.82 Typical High $169.82 | Professional | 56 · Pre-op care only | $81.28 | $169.82 | $169.82 |
MountainHealth Co-op Setting Professional Modifier 22 · Increased work Typical Low $1,258.93 Median $1,258.93 Typical High $1,258.93 | Professional | 22 · Increased work | $1,258.93 | $1,258.93 | $1,258.93 |
MountainHealth Co-op Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $114.82 Typical High $114.82 | Professional | 56 · Pre-op care only | $114.82 | $114.82 | $114.82 |
MountainHealth Co-op Setting Professional Modifier 62 · Two surgeons Typical Low $707.95 Median $707.95 Typical High $707.95 | Professional | 62 · Two surgeons | $707.95 | $707.95 | $707.95 |
MountainHealth Co-op Setting Professional Modifier 63 · Small infant Typical Low $1,258.93 Median $1,258.93 Typical High $1,258.93 | Professional | 63 · Small infant | $1,258.93 | $1,258.93 | $1,258.93 |
Where Idaho sits
The same service costs 4.0 times more in Oklahoma 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
OK $7,771MT $1,932
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.