How much rates vary
Facilitymedian $240 · 10th to 90th $204 to $339Professionalmedian $234 · 10th to 90th $200 to $257
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 $204.17 Median $257.04 Typical High $257.04 | Professional | None | $204.17 | $257.04 | $257.04 |
BCBS Idaho Setting Facility Modifier None Typical Low $213.80 Median $234.42 Typical High $338.84 | Facility | None | $213.80 | $234.42 | $338.84 |
BCBS Idaho Setting Professional Modifier None Typical Low $204.17 Median $229.09 Typical High $338.84 | Professional | None | $204.17 | $229.09 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $288.40 Median $288.40 Typical High $524.81 | Facility | None | $288.40 | $288.40 | $524.81 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | None | $204.17 | $204.17 | $204.17 |
Moda Health Setting Facility Modifier None Typical Low $204.17 Median $257.04 Typical High $257.04 | Facility | None | $204.17 | $257.04 | $257.04 |
Moda Health Setting Professional Modifier None Typical Low $204.17 Median $251.19 Typical High $257.04 | Professional | None | $204.17 | $251.19 | $257.04 |
Molina Setting Professional Modifier None Typical Low $141.25 Median $141.25 Typical High $165.96 | Professional | None | $141.25 | $141.25 | $165.96 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $223.87 Median $234.42 Typical High $309.03 | Facility | None | $223.87 | $234.42 | $309.03 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $199.53 Median $239.88 Typical High $257.04 | Professional | None | $199.53 | $239.88 | $257.04 |
Regence BlueShield Setting Facility Modifier None Typical Low $204.17 Median $288.40 Typical High $489.78 | Facility | None | $204.17 | $288.40 | $489.78 |
Regence BlueShield Setting Professional Modifier None Typical Low $223.87 Median $245.47 Typical High $245.47 | Professional | None | $223.87 | $245.47 | $245.47 |
Select Health Setting Facility Modifier None Typical Low $204.17 Median $204.17 Typical High $436.52 | Facility | None | $204.17 | $204.17 | $436.52 |
Select Health Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $295.12 | Professional | None | $204.17 | $204.17 | $295.12 |
United Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $213.80 | Professional | None | $199.53 | $199.53 | $213.80 |
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 $104.71 Median $128.82 Typical High $128.82 | Professional | 52 · Reduced service | $104.71 | $128.82 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $51.29 Typical High $51.29 | Professional | 53 · Discontinued | $41.69 | $51.29 | $51.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $38.90 Typical High $38.90 | Professional | 55 · Aftercare only | $30.90 | $38.90 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.89 Median $25.70 Typical High $25.70 | Professional | 56 · Pre-op care only | $20.89 | $25.70 | $25.70 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $158.49 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $134.90 | $158.49 | $158.49 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $109.65 Median $125.89 Typical High $125.89 | Professional | 52 · Reduced service | $109.65 | $125.89 | $125.89 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $50.12 Typical High $50.12 | Professional | 53 · Discontinued | $43.65 | $50.12 | $50.12 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $33.11 Median $38.02 Typical High $38.02 | Professional | 55 · Aftercare only | $33.11 | $38.02 | $38.02 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $25.12 Typical High $25.12 | Professional | 56 · Pre-op care only | $21.88 | $25.12 | $25.12 |
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
$234
AK $251NJ $204
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.