How much rates vary
Facilitymedian $89 · 10th to 90th $78 to $126Professionalmedian $87 · 10th to 90th $76 to $95
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 $114.82 Median $114.82 Typical High $114.82 | Facility | None | $114.82 | $114.82 | $114.82 |
Aetna Setting Professional Modifier None Typical Low $75.86 Median $95.50 Typical High $95.50 | Professional | None | $75.86 | $95.50 | $95.50 |
BCBS Idaho Setting Facility Modifier None Typical Low $79.43 Median $89.13 Typical High $125.89 | Facility | None | $79.43 | $89.13 | $125.89 |
BCBS Idaho Setting Professional Modifier None Typical Low $77.62 Median $85.11 Typical High $125.89 | Professional | None | $77.62 | $85.11 | $125.89 |
Cigna Setting Facility Modifier None Typical Low $107.15 Median $107.15 Typical High $194.98 | Facility | None | $107.15 | $107.15 | $194.98 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | None | $75.86 | $75.86 | $75.86 |
Moda Health Setting Facility Modifier None Typical Low $83.18 Median $95.50 Typical High $114.82 | Facility | None | $83.18 | $95.50 | $114.82 |
Moda Health Setting Professional Modifier None Typical Low $75.86 Median $93.33 Typical High $95.50 | Professional | None | $75.86 | $93.33 | $95.50 |
Molina Setting Professional Modifier None Typical Low $53.70 Median $53.70 Typical High $63.10 | Professional | None | $53.70 | $53.70 | $63.10 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $85.11 Median $87.10 Typical High $114.82 | Facility | None | $85.11 | $87.10 | $114.82 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $74.13 Median $91.20 Typical High $95.50 | Professional | None | $74.13 | $91.20 | $95.50 |
Regence BlueShield Setting Facility Modifier None Typical Low $75.86 Median $107.15 Typical High $181.97 | Facility | None | $75.86 | $107.15 | $181.97 |
Regence BlueShield Setting Professional Modifier None Typical Low $85.11 Median $91.20 Typical High $91.20 | Professional | None | $85.11 | $91.20 | $91.20 |
Select Health Setting Facility Modifier None Typical Low $75.86 Median $75.86 Typical High $162.18 | Facility | None | $75.86 | $75.86 | $162.18 |
Select Health Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $79.43 | Professional | None | $75.86 | $75.86 | $79.43 |
United Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $79.43 | Professional | None | $75.86 | $75.86 | $79.43 |
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 $38.90 Median $47.86 Typical High $47.86 | Professional | 52 · Reduced service | $38.90 | $47.86 | $47.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.49 Median $19.05 Typical High $19.05 | Professional | 53 · Discontinued | $15.49 | $19.05 | $19.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $72.44 Typical High $72.44 | Professional | 54 · Surgery only | $57.54 | $72.44 | $72.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $14.45 Typical High $14.45 | Professional | 55 · Aftercare only | $11.48 | $14.45 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $9.55 Typical High $9.55 | Professional | 56 · Pre-op care only | $7.76 | $9.55 | $9.55 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $51.29 Median $58.88 Typical High $58.88 | Professional | 78 · Unplanned return to OR | $51.29 | $58.88 | $58.88 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $40.74 Median $46.77 Typical High $46.77 | Professional | 52 · Reduced service | $40.74 | $46.77 | $46.77 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $19.05 Typical High $19.05 | Professional | 53 · Discontinued | $16.60 | $19.05 | $19.05 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $70.79 Typical High $70.79 | Professional | 54 · Surgery only | $61.66 | $70.79 | $70.79 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $14.13 Typical High $14.13 | Professional | 55 · Aftercare only | $12.30 | $14.13 | $14.13 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $9.33 Typical High $9.33 | Professional | 56 · Pre-op care only | $8.32 | $9.33 | $9.33 |
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
$87.10
AK $93.33NJ $75.86
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.