How much rates vary
Facilitymedian $501 · 10th to 90th $170 to $5,012Professionalmedian $501 · 10th to 90th $331 to $646
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 $363.08 Median $630.96 Typical High $1,023.29 | Professional | None | $363.08 | $630.96 | $1,023.29 |
BCBS Idaho Setting Facility Modifier None Typical Low $1,071.52 Median $2,344.23 Typical High $6,918.31 | Facility | None | $1,071.52 | $2,344.23 | $6,918.31 |
BCBS Idaho Setting Professional Modifier None Typical Low $426.58 Median $524.81 Typical High $724.44 | Professional | None | $426.58 | $524.81 | $724.44 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $489.78 Typical High $562.34 | Professional | None | $281.84 | $489.78 | $562.34 |
Moda Health Setting Facility Modifier None Typical Low $323.59 Median $1,071.52 Typical High $5,495.41 | Facility | None | $323.59 | $1,071.52 | $5,495.41 |
Moda Health Setting Professional Modifier None Typical Low $302.00 Median $489.78 Typical High $630.96 | Professional | None | $302.00 | $489.78 | $630.96 |
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 $380.19 Median $467.74 Typical High $467.74 | Facility | None | $380.19 | $467.74 | $467.74 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $407.38 Median $467.74 Typical High $724.44 | Professional | None | $407.38 | $467.74 | $724.44 |
Regence BlueShield Setting Professional Modifier None Typical Low $489.78 Median $575.44 Typical High $575.44 | Professional | None | $489.78 | $575.44 | $575.44 |
Select Health Setting Facility Modifier None Typical Low $223.87 Median $223.87 Typical High $4,677.35 | Facility | None | $223.87 | $223.87 | $4,677.35 |
Select Health Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $524.81 | Professional | None | $223.87 | $223.87 | $524.81 |
United Setting Facility Modifier None Typical Low $144.54 Median $363.08 Typical High $501.19 | Facility | None | $144.54 | $363.08 | $501.19 |
United Setting Professional Modifier None Typical Low $363.08 Median $467.74 Typical High $691.83 | Professional | None | $363.08 | $467.74 | $691.83 |
18 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 $257.04 Median $316.23 Typical High $316.23 | Professional | 52 · Reduced service | $257.04 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $104.71 Median $125.89 Typical High $125.89 | Professional | 53 · Discontinued | $104.71 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $389.05 Median $478.63 Typical High $478.63 | Professional | 54 · Surgery only | $389.05 | $478.63 | $478.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $77.62 Median $95.50 Typical High $95.50 | Professional | 55 · Aftercare only | $77.62 | $95.50 | $95.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $51.29 Median $63.10 Typical High $63.10 | Professional | 56 · Pre-op care only | $51.29 | $63.10 | $63.10 |
BCBS Idaho Setting Professional Modifier 54 · Surgery only Typical Low $380.19 Median $446.68 Typical High $645.65 | Professional | 54 · Surgery only | $380.19 | $446.68 | $645.65 |
BCBS Idaho Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $50.12 Typical High $72.44 | Professional | 55 · Aftercare only | $41.69 | $50.12 | $72.44 |
BCBS Idaho Setting Professional Modifier 63 · Small infant Typical Low $501.19 Median $588.84 Typical High $870.96 | Professional | 63 · Small infant | $501.19 | $588.84 | $870.96 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $295.12 Median $346.74 Typical High $501.19 | Professional | 78 · Unplanned return to OR | $295.12 | $346.74 | $501.19 |
BCBS Idaho Setting Professional Modifier 80 · Assistant surgeon Typical Low $67.61 Median $79.43 Typical High $114.82 | Professional | 80 · Assistant surgeon | $67.61 | $79.43 | $114.82 |
BCBS Idaho Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $67.61 Median $79.43 Typical High $114.82 | Professional | 81 · Minimal assistant surgeon | $67.61 | $79.43 | $114.82 |
BCBS Idaho Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $67.61 Median $79.43 Typical High $114.82 | Professional | 82 · Assistant surgeon, no resident | $67.61 | $79.43 | $114.82 |
BCBS Idaho Setting Professional Modifier AS · PA/NP assist Typical Low $57.54 Median $67.61 Typical High $97.72 | Professional | AS · PA/NP assist | $57.54 | $67.61 | $97.72 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $269.15 Median $316.23 Typical High $316.23 | Professional | 52 · Reduced service | $269.15 | $316.23 | $316.23 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $107.15 Median $125.89 Typical High $125.89 | Professional | 53 · Discontinued | $107.15 | $125.89 | $125.89 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $398.11 Median $478.63 Typical High $478.63 | Professional | 54 · Surgery only | $398.11 | $478.63 | $478.63 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $81.28 Median $95.50 Typical High $95.50 | Professional | 55 · Aftercare only | $81.28 | $95.50 | $95.50 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $53.70 Median $63.10 Typical High $63.10 | Professional | 56 · Pre-op care only | $53.70 | $63.10 | $63.10 |
Where Idaho sits
The same service costs 10.0 times more in New York than in Delaware. 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
NY $4,696DE $472
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.