How much rates vary
Facilitymedian $10 · 10th to 90th $6 to $42Professionalmedian $9 · 10th to 90th $7 to $10
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 $10.72 Median $12.02 Typical High $16.60 | Facility | None | $10.72 | $12.02 | $16.60 |
Aetna Setting Professional Modifier None Typical Low $8.13 Median $10.23 Typical High $10.23 | Professional | None | $8.13 | $10.23 | $10.23 |
BCBS Idaho Setting Facility Modifier None Typical Low $2.95 Median $7.76 Typical High $12.88 | Facility | None | $2.95 | $7.76 | $12.88 |
BCBS Idaho Setting Professional Modifier None Typical Low $8.91 Median $9.77 Typical High $9.77 | Professional | None | $8.91 | $9.77 | $9.77 |
Cigna Setting Facility Modifier None Typical Low $8.91 Median $9.12 Typical High $20.42 | Facility | None | $8.91 | $9.12 | $20.42 |
Cigna Setting Professional Modifier None Typical Low $8.13 Median $8.13 Typical High $8.13 | Professional | None | $8.13 | $8.13 | $8.13 |
Moda Health Setting Facility Modifier None Typical Low $9.12 Median $15.14 Typical High $63.10 | Facility | None | $9.12 | $15.14 | $63.10 |
Moda Health Setting Professional Modifier None Typical Low $7.94 Median $9.12 Typical High $10.23 | Professional | None | $7.94 | $9.12 | $10.23 |
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 $8.51 Median $8.91 Typical High $11.22 | Facility | None | $8.51 | $8.91 | $11.22 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $7.24 Median $8.71 Typical High $10.23 | Professional | None | $7.24 | $8.71 | $10.23 |
Regence BlueShield Setting Professional Modifier None Typical Low $8.13 Median $9.77 Typical High $10.23 | Professional | None | $8.13 | $9.77 | $10.23 |
Select Health Setting Facility Modifier None Typical Low $8.13 Median $8.13 Typical High $14.45 | Facility | None | $8.13 | $8.13 | $14.45 |
Select Health Setting Professional Modifier None Typical Low $8.13 Median $8.13 Typical High $8.51 | Professional | None | $8.13 | $8.13 | $8.51 |
United Setting Professional Modifier None Typical Low $7.24 Median $7.24 Typical High $7.24 | Professional | None | $7.24 | $7.24 | $7.24 |
10 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 $4.07 Median $5.13 Typical High $5.13 | Professional | 52 · Reduced service | $4.07 | $5.13 | $5.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.62 Median $2.04 Typical High $2.04 | Professional | 53 · Discontinued | $1.62 | $2.04 | $2.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.23 Median $1.51 Typical High $1.51 | Professional | 55 · Aftercare only | $1.23 | $1.51 | $1.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.81 Median $1.02 Typical High $1.02 | Professional | 56 · Pre-op care only | $0.81 | $1.02 | $1.02 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $5.89 Median $6.31 Typical High $6.92 | Professional | 78 · Unplanned return to OR | $5.89 | $6.31 | $6.92 |
Moda Health Setting Facility Modifier JZ · No drug discarded Typical Low $13.49 Median $28.84 Typical High $33.88 | Facility | JZ · No drug discarded | $13.49 | $28.84 | $33.88 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $3.89 Median $4.47 Typical High $4.47 | Professional | 52 · Reduced service | $3.89 | $4.47 | $4.47 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $1.58 Median $1.82 Typical High $1.82 | Professional | 53 · Discontinued | $1.58 | $1.82 | $1.82 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $1.17 Median $1.35 Typical High $1.35 | Professional | 55 · Aftercare only | $1.17 | $1.35 | $1.35 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.79 Median $0.89 Typical High $0.89 | Professional | 56 · Pre-op care only | $0.79 | $0.89 | $0.89 |
Where Idaho sits
Rates are fairly even across states for this service. 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· 4th of 51
$9.12
AK $10.72NC $7.24
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.