How much rates vary
Facilitymedian $3,631 · 10th to 90th $550 to $16,982Professionalmedian $7,762 · 10th to 90th $5,012 to $10,233
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 $4,466.84 Median $6,165.95 Typical High $10,232.93 | Professional | None | $4,466.84 | $6,165.95 | $10,232.93 |
BCBS Idaho Setting Facility Modifier None Typical Low $15,488.17 Median $16,595.87 Typical High $19,952.62 | Facility | None | $15,488.17 | $16,595.87 | $19,952.62 |
BCBS Idaho Setting Professional Modifier None Typical Low $7,079.46 Median $8,317.64 Typical High $9,120.11 | Professional | None | $7,079.46 | $8,317.64 | $9,120.11 |
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 $5,248.07 Median $6,309.57 Typical High $7,244.36 | Professional | None | $5,248.07 | $6,309.57 | $7,244.36 |
Moda Health Setting Facility Modifier None Typical Low $3,630.78 Median $5,495.41 Typical High $14,791.08 | Facility | None | $3,630.78 | $5,495.41 | $14,791.08 |
Moda Health Setting Professional Modifier None Typical Low $5,370.32 Median $8,511.38 Typical High $10,232.93 | Professional | None | $5,370.32 | $8,511.38 | $10,232.93 |
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 $6,309.57 Median $7,762.47 Typical High $7,762.47 | Facility | None | $6,309.57 | $7,762.47 | $7,762.47 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $7,762.47 Median $7,762.47 Typical High $9,772.37 | Professional | None | $7,762.47 | $7,762.47 | $9,772.37 |
Regence BlueShield Setting Professional Modifier None Typical Low $7,943.28 Median $9,120.11 Typical High $10,232.93 | Professional | None | $7,943.28 | $9,120.11 | $10,232.93 |
Select Health Setting Facility Modifier None Typical Low $3,630.78 Median $3,630.78 Typical High $4,073.80 | Facility | None | $3,630.78 | $3,630.78 | $4,073.80 |
Select Health Setting Professional Modifier None Typical Low $3,630.78 Median $3,630.78 Typical High $5,370.32 | Professional | None | $3,630.78 | $3,630.78 | $5,370.32 |
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 $4,570.88 Median $6,606.93 Typical High $9,772.37 | Professional | None | $4,570.88 | $6,606.93 | $9,772.37 |
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 $2,691.53 Median $5,128.61 Typical High $5,128.61 | Professional | 52 · Reduced service | $2,691.53 | $5,128.61 | $5,128.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1,096.48 Median $2,041.74 Typical High $2,041.74 | Professional | 53 · Discontinued | $1,096.48 | $2,041.74 | $2,041.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $4,073.80 Median $7,762.47 Typical High $7,762.47 | Professional | 54 · Surgery only | $4,073.80 | $7,762.47 | $7,762.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $812.83 Median $1,548.82 Typical High $1,548.82 | Professional | 55 · Aftercare only | $812.83 | $1,548.82 | $1,548.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $537.03 Median $1,023.29 Typical High $1,023.29 | Professional | 56 · Pre-op care only | $537.03 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,801.89 Median $7,244.36 Typical High $7,244.36 | Professional | 78 · Unplanned return to OR | $3,801.89 | $7,244.36 | $7,244.36 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $6,165.95 Median $7,244.36 Typical High $7,762.47 | Professional | 54 · Surgery only | $6,165.95 | $7,244.36 | $7,762.47 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $691.83 Median $794.33 Typical High $870.96 | Professional | 55 · Aftercare only | $691.83 | $794.33 | $870.96 |
BCBS Idaho Setting Professional Modifier 62 · Two surgeons Typical Low $4,365.16 Median $5,011.87 Typical High $5,370.32 | Professional | 62 · Two surgeons | $4,365.16 | $5,011.87 | $5,370.32 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $8,317.64 Median $9,549.93 Typical High $10,471.29 | Professional | 63 · Small infant | $8,317.64 | $9,549.93 | $10,471.29 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $4,897.79 Median $5,623.41 Typical High $6,025.60 | Professional | 78 · Unplanned return to OR | $4,897.79 | $5,623.41 | $6,025.60 |
BCBS Idaho Setting Professional Modifier 80 · Assistant surgeon Typical Low $1,096.48 Median $1,288.25 Typical High $1,380.38 | Professional | 80 · Assistant surgeon | $1,096.48 | $1,288.25 | $1,380.38 |
BCBS Idaho Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $1,096.48 Median $1,288.25 Typical High $1,380.38 | Professional | 81 · Minimal assistant surgeon | $1,096.48 | $1,288.25 | $1,380.38 |
BCBS Idaho Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $1,096.48 Median $1,288.25 Typical High $1,380.38 | Professional | 82 · Assistant surgeon, no resident | $1,096.48 | $1,288.25 | $1,380.38 |
BCBS Idaho Setting Professional Modifier AS · PA/NP assist Typical Low $933.25 Median $1,096.48 Typical High $1,174.90 | Professional | AS · PA/NP assist | $933.25 | $1,096.48 | $1,174.90 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $2,691.53 Median $5,128.61 Typical High $5,128.61 | Professional | 52 · Reduced service | $2,691.53 | $5,128.61 | $5,128.61 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $1,096.48 Median $2,041.74 Typical High $2,041.74 | Professional | 53 · Discontinued | $1,096.48 | $2,041.74 | $2,041.74 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $4,073.80 Median $7,762.47 Typical High $7,762.47 | Professional | 54 · Surgery only | $4,073.80 | $7,762.47 | $7,762.47 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $812.83 Median $1,548.82 Typical High $1,548.82 | Professional | 55 · Aftercare only | $812.83 | $1,548.82 | $1,548.82 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $537.03 Median $1,023.29 Typical High $1,023.29 | Professional | 56 · Pre-op care only | $537.03 | $1,023.29 | $1,023.29 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,801.89 Median $7,244.36 Typical High $7,244.36 | Professional | 78 · Unplanned return to OR | $3,801.89 | $7,244.36 | $7,244.36 |
Where Idaho sits
The same service costs 8.7 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 $38,525WA $4,436
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.