How much rates vary
Facilitymedian $1,047 · 10th to 90th $550 to $5,129Professionalmedian $1,995 · 10th to 90th $1,413 to $2,818
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 $1,513.56 Median $2,818.38 Typical High $2,818.38 | Professional | None | $1,513.56 | $2,818.38 | $2,818.38 |
BCBS Idaho Setting Facility Modifier None Typical Low $4,466.84 Median $4,897.79 Typical High $5,888.44 | Facility | None | $4,466.84 | $4,897.79 | $5,888.44 |
BCBS Idaho Setting Professional Modifier None Typical Low $1,905.46 Median $2,089.30 Typical High $2,454.71 | Professional | None | $1,905.46 | $2,089.30 | $2,454.71 |
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 $1,584.89 Median $1,819.70 Typical High $2,137.96 | Professional | None | $1,584.89 | $1,819.70 | $2,137.96 |
Moda Health Setting Facility Modifier None Typical Low $1,047.13 Median $2,818.38 Typical High $5,495.41 | Facility | None | $1,047.13 | $2,818.38 | $5,495.41 |
Moda Health Setting Professional Modifier None Typical Low $1,584.89 Median $2,398.83 Typical High $2,818.38 | Professional | None | $1,584.89 | $2,398.83 | $2,818.38 |
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 $1,819.70 Median $2,187.76 Typical High $2,187.76 | Facility | None | $1,819.70 | $2,187.76 | $2,187.76 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $2,187.76 Median $2,187.76 Typical High $2,570.40 | Professional | None | $2,187.76 | $2,187.76 | $2,570.40 |
Regence BlueShield Setting Professional Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $2,398.83 | Professional | None | $1,905.46 | $1,905.46 | $2,398.83 |
Select Health Setting Facility Modifier None Typical Low $1,047.13 Median $1,047.13 Typical High $1,096.48 | Facility | None | $1,047.13 | $1,047.13 | $1,096.48 |
Select Health Setting Professional Modifier None Typical Low $1,047.13 Median $1,047.13 Typical High $1,621.81 | Professional | None | $1,047.13 | $1,047.13 | $1,621.81 |
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 $1,258.93 Median $1,819.70 Typical High $2,691.53 | Professional | None | $1,258.93 | $1,819.70 | $2,691.53 |
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 $1,412.54 Typical High $1,412.54 | Professional | 52 · Reduced service | $794.33 | $1,412.54 | $1,412.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $562.34 Typical High $562.34 | Professional | 53 · Discontinued | $316.23 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $2,137.96 Typical High $2,137.96 | Professional | 54 · Surgery only | $1,174.90 | $2,137.96 | $2,137.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $426.58 Typical High $426.58 | Professional | 55 · Aftercare only | $234.42 | $426.58 | $426.58 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $281.84 Typical High $281.84 | Professional | 56 · Pre-op care only | $158.49 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,995.26 Typical High $1,995.26 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,995.26 | $1,995.26 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $1,778.28 Median $2,137.96 Typical High $2,238.72 | Professional | 54 · Surgery only | $1,778.28 | $2,137.96 | $2,238.72 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $234.42 Typical High $245.47 | Professional | 55 · Aftercare only | $199.53 | $234.42 | $245.47 |
BCBS Idaho Setting Professional Modifier 62 · Two surgeons Typical Low $1,230.27 Median $1,479.11 Typical High $1,548.82 | Professional | 62 · Two surgeons | $1,230.27 | $1,479.11 | $1,548.82 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $2,398.83 Median $2,818.38 Typical High $2,951.21 | Professional | 63 · Small infant | $2,398.83 | $2,818.38 | $2,951.21 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,380.38 Median $1,659.59 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $1,380.38 | $1,659.59 | $1,737.80 |
BCBS Idaho Setting Professional Modifier 80 · Assistant surgeon Typical Low $316.23 Median $380.19 Typical High $398.11 | Professional | 80 · Assistant surgeon | $316.23 | $380.19 | $398.11 |
BCBS Idaho Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $316.23 Median $380.19 Typical High $398.11 | Professional | 81 · Minimal assistant surgeon | $316.23 | $380.19 | $398.11 |
BCBS Idaho Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $316.23 Median $380.19 Typical High $398.11 | Professional | 82 · Assistant surgeon, no resident | $316.23 | $380.19 | $398.11 |
BCBS Idaho Setting Professional Modifier AS · PA/NP assist Typical Low $269.15 Median $323.59 Typical High $338.84 | Professional | AS · PA/NP assist | $269.15 | $323.59 | $338.84 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $794.33 Median $1,412.54 Typical High $1,412.54 | Professional | 52 · Reduced service | $794.33 | $1,412.54 | $1,412.54 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $562.34 Typical High $562.34 | Professional | 53 · Discontinued | $323.59 | $562.34 | $562.34 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $2,137.96 Typical High $2,137.96 | Professional | 54 · Surgery only | $1,202.26 | $2,137.96 | $2,137.96 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $426.58 Typical High $426.58 | Professional | 55 · Aftercare only | $239.88 | $426.58 | $426.58 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $281.84 Typical High $281.84 | Professional | 56 · Pre-op care only | $158.49 | $281.84 | $281.84 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,995.26 Typical High $1,995.26 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,995.26 | $1,995.26 |
Where Idaho sits
The same service costs 9.0 times more in Maine 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
ME $17,266MD $1,911
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.