How much rates vary
Facilitymedian $977 · 10th to 90th $288 to $3,548Professionalmedian $316 · 10th to 90th $162 to $676
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 $190.55 Median $354.81 Typical High $5,495.41 | Facility | None | $190.55 | $354.81 | $5,495.41 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $295.12 Typical High $389.05 | Professional | None | $162.18 | $295.12 | $389.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $77.62 Typical High $151.36 | Professional | 53 · Discontinued | $32.36 | $77.62 | $151.36 |
BCBS Idaho Setting Facility Modifier None Typical Low $954.99 Median $1,548.82 Typical High $2,951.21 | Facility | None | $954.99 | $1,548.82 | $2,951.21 |
BCBS Idaho Setting Professional Modifier None Typical Low $269.15 Median $426.58 Typical High $794.33 | Professional | None | $269.15 | $426.58 | $794.33 |
BCBS Idaho Setting Professional Modifier 53 · Discontinued Typical Low $134.90 Median $173.78 Typical High $398.11 | Professional | 53 · Discontinued | $134.90 | $173.78 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $501.19 Typical High $512.86 | Facility | None | $426.58 | $501.19 | $512.86 |
Cigna Setting Professional Modifier None Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | None | $302.00 | $302.00 | $302.00 |
Moda Health Setting Facility Modifier None Typical Low $190.55 Median $2,818.38 Typical High $5,495.41 | Facility | None | $190.55 | $2,818.38 | $5,495.41 |
Moda Health Setting Professional Modifier None Typical Low $162.18 Median $295.12 Typical High $630.96 | Professional | None | $162.18 | $295.12 | $630.96 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $77.62 Typical High $151.36 | Professional | 53 · Discontinued | $32.36 | $77.62 | $151.36 |
Molina Setting Professional Modifier None Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | None | $30.20 | $30.20 | $30.20 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $169.82 Median $389.05 Typical High $977.24 | Facility | None | $169.82 | $389.05 | $977.24 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $169.82 Median $346.74 Typical High $588.84 | Professional | None | $169.82 | $346.74 | $588.84 |
MountainHealth Co-op Setting Professional Modifier 53 · Discontinued Typical Low $95.50 Median $114.82 Typical High $229.09 | Professional | 53 · Discontinued | $95.50 | $114.82 | $229.09 |
Regence BlueShield Setting Facility Modifier None Typical Low $1,548.82 Median $2,041.74 Typical High $3,019.95 | Facility | None | $1,548.82 | $2,041.74 | $3,019.95 |
Regence BlueShield Setting Professional Modifier None Typical Low $229.09 Median $389.05 Typical High $575.44 | Professional | None | $229.09 | $389.05 | $575.44 |
Regence BlueShield Setting Professional Modifier 53 · Discontinued Typical Low $114.82 Median $194.98 Typical High $288.40 | Professional | 53 · Discontinued | $114.82 | $194.98 | $288.40 |
Select Health Setting Facility Modifier None Typical Low $346.74 Median $354.81 Typical High $1,621.81 | Facility | None | $346.74 | $354.81 | $1,621.81 |
Select Health Setting Professional Modifier None Typical Low $204.17 Median $346.74 Typical High $346.74 | Professional | None | $204.17 | $346.74 | $346.74 |
United Setting Facility Modifier None Typical Low $363.08 Median $501.19 Typical High $724.44 | Facility | None | $363.08 | $501.19 | $724.44 |
United Setting Professional Modifier None Typical Low $204.17 Median $363.08 Typical High $660.69 | Professional | None | $204.17 | $363.08 | $660.69 |
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 $81.28 Median $102.33 Typical High $151.36 | Professional | 52 · Reduced service | $81.28 | $102.33 | $151.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $120.23 Median $177.83 Typical High $223.87 | Professional | 54 · Surgery only | $120.23 | $177.83 | $223.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $35.48 Typical High $45.71 | Professional | 55 · Aftercare only | $23.99 | $35.48 | $45.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $23.44 Typical High $30.20 | Professional | 56 · Pre-op care only | $16.22 | $23.44 | $30.20 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $208.93 Median $478.63 Typical High $562.34 | Professional | 78 · Unplanned return to OR | $208.93 | $478.63 | $562.34 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $81.28 Median $102.33 Typical High $151.36 | Professional | 52 · Reduced service | $81.28 | $102.33 | $151.36 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $120.23 Median $177.83 Typical High $223.87 | Professional | 54 · Surgery only | $120.23 | $177.83 | $223.87 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $35.48 Typical High $45.71 | Professional | 55 · Aftercare only | $23.99 | $35.48 | $45.71 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $23.99 Typical High $30.20 | Professional | 56 · Pre-op care only | $16.22 | $23.99 | $30.20 |
MountainHealth Co-op Setting Professional Modifier 54 · Surgery only Typical Low $218.78 Median $218.78 Typical High $407.38 | Professional | 54 · Surgery only | $218.78 | $218.78 | $407.38 |
MountainHealth Co-op Setting Professional Modifier 56 · Pre-op care only Typical Low $31.62 Median $31.62 Typical High $58.88 | Professional | 56 · Pre-op care only | $31.62 | $31.62 | $58.88 |
MountainHealth Co-op Setting Professional Modifier 78 · Unplanned return to OR Typical Low $234.42 Median $234.42 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $234.42 | $234.42 | $436.52 |
Where Idaho sits
The same service costs 5.8 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 $4,478ME $766
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.