How much rates vary
Facilitymedian $2,455 · 10th to 90th $759 to $8,913Professionalmedian $490 · 10th to 90th $288 to $2,512
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 $416.87 Median $2,818.38 Typical High $4,786.30 | Facility | None | $416.87 | $2,818.38 | $4,786.30 |
Aetna Setting Professional Modifier None Typical Low $269.15 Median $407.38 Typical High $2,398.83 | Professional | None | $269.15 | $407.38 | $2,398.83 |
BCBS Idaho Setting Facility Modifier None Typical Low $2,344.23 Median $3,467.37 Typical High $8,128.31 | Facility | None | $2,344.23 | $3,467.37 | $8,128.31 |
BCBS Idaho Setting Professional Modifier None Typical Low $354.81 Median $1,995.26 Typical High $2,754.23 | Professional | None | $354.81 | $1,995.26 | $2,754.23 |
Cigna Setting Facility Modifier None Typical Low $1,905.46 Median $2,137.96 Typical High $2,884.03 | Facility | None | $1,905.46 | $2,137.96 | $2,884.03 |
Cigna Setting Professional Modifier None Typical Low $323.59 Median $436.52 Typical High $2,238.72 | Professional | None | $323.59 | $436.52 | $2,238.72 |
Moda Health Setting Facility Modifier None Typical Low $398.11 Median $5,888.44 Typical High $10,964.78 | Facility | None | $398.11 | $5,888.44 | $10,964.78 |
Moda Health Setting Professional Modifier None Typical Low $269.15 Median $489.78 Typical High $2,511.89 | Professional | None | $269.15 | $489.78 | $2,511.89 |
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 $398.11 Median $398.11 Typical High $2,454.71 | Facility | None | $398.11 | $398.11 | $2,454.71 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $398.11 Median $691.83 Typical High $2,630.27 | Professional | None | $398.11 | $691.83 | $2,630.27 |
Regence BlueShield Setting Facility Modifier None Typical Low $5,128.61 Median $7,079.46 Typical High $10,232.93 | Facility | None | $5,128.61 | $7,079.46 | $10,232.93 |
Regence BlueShield Setting Professional Modifier None Typical Low $354.81 Median $467.74 Typical High $2,344.23 | Professional | None | $354.81 | $467.74 | $2,344.23 |
Select Health Setting Facility Modifier None Typical Low $1,174.90 Median $1,202.26 Typical High $6,456.54 | Facility | None | $1,174.90 | $1,202.26 | $6,456.54 |
Select Health Setting Professional Modifier None Typical Low $251.19 Median $1,174.90 Typical High $1,548.82 | Professional | None | $251.19 | $1,174.90 | $1,548.82 |
United Setting Facility Modifier None Typical Low $1,047.13 Median $1,412.54 Typical High $1,621.81 | Facility | None | $1,047.13 | $1,412.54 | $1,621.81 |
United Setting Professional Modifier None Typical Low $257.04 Median $501.19 Typical High $2,089.30 | Professional | None | $257.04 | $501.19 | $2,089.30 |
15 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 $134.90 Median $199.53 Typical High $1,174.90 | Professional | 52 · Reduced service | $134.90 | $199.53 | $1,174.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $53.70 Median $79.43 Typical High $478.63 | Professional | 53 · Discontinued | $53.70 | $79.43 | $478.63 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $199.53 Median $302.00 Typical High $1,778.28 | Professional | 54 · Surgery only | $199.53 | $302.00 | $1,778.28 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $39.81 Median $60.26 Typical High $354.81 | Professional | 55 · Aftercare only | $39.81 | $60.26 | $354.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.92 Median $39.81 Typical High $239.88 | Professional | 56 · Pre-op care only | $26.92 | $39.81 | $239.88 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $316.23 Median $389.05 Typical High $2,290.87 | Professional | 54 · Surgery only | $316.23 | $389.05 | $2,290.87 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $36.31 Median $44.67 Typical High $275.42 | Professional | 55 · Aftercare only | $36.31 | $44.67 | $275.42 |
BCBS Idaho Setting Professional Modifier 62 · Two surgeons Typical Low $229.09 Median $436.52 Typical High $1,737.80 | Professional | 62 · Two surgeons | $229.09 | $436.52 | $1,737.80 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $436.52 Median $2,691.53 Typical High $3,311.31 | Professional | 63 · Small infant | $436.52 | $2,691.53 | $3,311.31 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $257.04 Median $309.03 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $257.04 | $309.03 | $1,862.09 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $134.90 Median $199.53 Typical High $1,174.90 | Professional | 52 · Reduced service | $134.90 | $199.53 | $1,174.90 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $53.70 Median $79.43 Typical High $478.63 | Professional | 53 · Discontinued | $53.70 | $79.43 | $478.63 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $199.53 Median $302.00 Typical High $1,778.28 | Professional | 54 · Surgery only | $199.53 | $302.00 | $1,778.28 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $39.81 Median $60.26 Typical High $354.81 | Professional | 55 · Aftercare only | $39.81 | $60.26 | $354.81 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $26.92 Median $39.81 Typical High $239.88 | Professional | 56 · Pre-op care only | $26.92 | $39.81 | $239.88 |
Where Idaho sits
The same service costs 4.3 times more in Vermont than in Maine. 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 $8,043ME $1,891
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.