How much rates vary
Facilitymedian $219 · 10th to 90th $174 to $380Professionalmedian $191 · 10th to 90th $162 to $214
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 $173.78 Median $213.80 Typical High $213.80 | Professional | None | $173.78 | $213.80 | $213.80 |
BCBS Idaho Setting Facility Modifier None Typical Low $158.49 Median $229.09 Typical High $389.05 | Facility | None | $158.49 | $229.09 | $389.05 |
BCBS Idaho Setting Professional Modifier None Typical Low $181.97 Median $190.55 Typical High $208.93 | Professional | None | $181.97 | $190.55 | $208.93 |
Cigna Setting Facility Modifier None Typical Low $239.88 Median $245.47 Typical High $436.52 | Facility | None | $239.88 | $245.47 | $436.52 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | None | $173.78 | $173.78 | $173.78 |
Moda Health Setting Facility Modifier None Typical Low $173.78 Median $213.80 Typical High $213.80 | Facility | None | $173.78 | $213.80 | $213.80 |
Moda Health Setting Professional Modifier None Typical Low $173.78 Median $204.17 Typical High $213.80 | Professional | None | $173.78 | $204.17 | $213.80 |
Molina Setting Professional Modifier None Typical Low $112.20 Median $112.20 Typical High $131.83 | Professional | None | $112.20 | $112.20 | $131.83 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $190.55 Median $190.55 Typical High $251.19 | Facility | None | $190.55 | $190.55 | $251.19 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $162.18 Median $194.98 Typical High $213.80 | Professional | None | $162.18 | $194.98 | $213.80 |
Regence BlueShield Setting Facility Modifier None Typical Low $158.49 Median $229.09 Typical High $389.05 | Facility | None | $158.49 | $229.09 | $389.05 |
Regence BlueShield Setting Professional Modifier None Typical Low $190.55 Median $208.93 Typical High $213.80 | Professional | None | $190.55 | $208.93 | $213.80 |
Select Health Setting Facility Modifier None Typical Low $173.78 Median $173.78 Typical High $363.08 | Facility | None | $173.78 | $173.78 | $363.08 |
Select Health Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $177.83 | Professional | None | $173.78 | $173.78 | $177.83 |
United Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $173.78 | Professional | None | $162.18 | $162.18 | $173.78 |
11 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 $87.10 Median $107.15 Typical High $107.15 | Professional | 52 · Reduced service | $87.10 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $43.65 Typical High $43.65 | Professional | 53 · Discontinued | $34.67 | $43.65 | $43.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $162.18 Typical High $162.18 | Professional | 54 · Surgery only | $131.83 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $32.36 Typical High $32.36 | Professional | 55 · Aftercare only | $26.30 | $32.36 | $32.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $21.38 Typical High $21.38 | Professional | 56 · Pre-op care only | $17.38 | $21.38 | $21.38 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $131.83 Typical High $134.90 | Professional | 78 · Unplanned return to OR | $114.82 | $131.83 | $134.90 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $89.13 Median $102.33 Typical High $102.33 | Professional | 52 · Reduced service | $89.13 | $102.33 | $102.33 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $40.74 Typical High $40.74 | Professional | 53 · Discontinued | $35.48 | $40.74 | $40.74 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $154.88 Typical High $154.88 | Professional | 54 · Surgery only | $134.90 | $154.88 | $154.88 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $30.90 Typical High $30.90 | Professional | 55 · Aftercare only | $26.92 | $30.90 | $30.90 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $20.42 Typical High $20.42 | Professional | 56 · Pre-op care only | $17.78 | $20.42 | $20.42 |
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· 2nd of 51
$191
AK $214AZ $166
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.