How much rates vary
Facilitymedian $1 · 10th to 90th $1 to $3Professionalmedian $1 · 10th to 90th $1 to $1
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 Professional Modifier None Typical Low $0.87 Median $1.07 Typical High $1.07 | Professional | None | $0.87 | $1.07 | $1.07 |
BCBS Idaho Setting Facility Modifier None Typical Low $1.02 Median $1.62 Typical High $7.08 | Facility | None | $1.02 | $1.62 | $7.08 |
BCBS Idaho Setting Professional Modifier None Typical Low $0.95 Median $1.05 Typical High $2.82 | Professional | None | $0.95 | $1.05 | $2.82 |
Cigna Setting Facility Modifier None Typical Low $0.95 Median $0.98 Typical High $2.19 | Facility | None | $0.95 | $0.98 | $2.19 |
Cigna Setting Professional Modifier None Typical Low $0.85 Median $0.85 Typical High $0.85 | Professional | None | $0.85 | $0.85 | $0.85 |
Moda Health Setting Facility Modifier None Typical Low $0.85 Median $1.07 Typical High $1.26 | Facility | None | $0.85 | $1.07 | $1.26 |
Moda Health Setting Professional Modifier None Typical Low $0.85 Median $1.12 Typical High $1.26 | Professional | None | $0.85 | $1.12 | $1.26 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $0.95 Median $1.15 Typical High $1.51 | Facility | None | $0.95 | $1.15 | $1.51 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $1.00 Median $1.07 Typical High $1.20 | Professional | None | $1.00 | $1.07 | $1.20 |
Regence BlueShield Setting Facility Modifier None Typical Low $0.89 Median $1.38 Typical High $2.51 | Facility | None | $0.89 | $1.38 | $2.51 |
Regence BlueShield Setting Professional Modifier None Typical Low $0.85 Median $1.05 Typical High $1.07 | Professional | None | $0.85 | $1.05 | $1.07 |
Select Health Setting Facility Modifier None Typical Low $0.69 Median $0.85 Typical High $1.82 | Facility | None | $0.69 | $0.85 | $1.82 |
Select Health Setting Professional Modifier None Typical Low $0.85 Median $0.85 Typical High $4.90 | Professional | None | $0.85 | $0.85 | $4.90 |
United Setting Professional Modifier None Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | None | $1.00 | $1.00 | $1.00 |
9 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 $0.44 Median $0.54 Typical High $0.54 | Professional | 52 · Reduced service | $0.44 | $0.54 | $0.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.17 Median $0.22 Typical High $0.22 | Professional | 53 · Discontinued | $0.17 | $0.22 | $0.22 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.13 Median $0.16 Typical High $0.16 | Professional | 55 · Aftercare only | $0.13 | $0.16 | $0.16 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.09 Median $0.11 Typical High $0.11 | Professional | 56 · Pre-op care only | $0.09 | $0.11 | $0.11 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $0.65 Median $0.68 Typical High $1.86 | Professional | 78 · Unplanned return to OR | $0.65 | $0.68 | $1.86 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $0.56 Median $0.65 Typical High $0.65 | Professional | 52 · Reduced service | $0.56 | $0.65 | $0.65 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.22 Median $0.25 Typical High $0.25 | Professional | 53 · Discontinued | $0.22 | $0.25 | $0.25 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.17 Median $0.19 Typical High $0.19 | Professional | 55 · Aftercare only | $0.17 | $0.19 | $0.19 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.11 Median $0.13 Typical High $0.13 | Professional | 56 · Pre-op care only | $0.11 | $0.13 | $0.13 |
Where Idaho sits
The same service costs 3.7 times more in North Carolina than in Virginia. 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.
Idaho· 5th of 51
$1.05
NC $3.16VA $0.85
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.