How much rates vary
Facilitymedian $38 · 10th to 90th $31 to $1,380Professionalmedian $39 · 10th to 90th $15 to $68
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 $20.89 Median $48.98 Typical High $58.88 | Professional | None | $20.89 | $48.98 | $58.88 |
BCBS Idaho Setting Facility Modifier None Typical Low $26.30 Median $35.48 Typical High $58.88 | Facility | None | $26.30 | $35.48 | $58.88 |
BCBS Idaho Setting Professional Modifier None Typical Low $26.30 Median $38.90 Typical High $40.74 | Professional | None | $26.30 | $38.90 | $40.74 |
Cigna Setting Professional Modifier None Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | None | $15.14 | $15.14 | $15.14 |
Moda Health Setting Facility Modifier None Typical Low $35.48 Median $37.15 Typical High $70.79 | Facility | None | $35.48 | $37.15 | $70.79 |
Moda Health Setting Professional Modifier None Typical Low $30.90 Median $38.90 Typical High $56.23 | Professional | None | $30.90 | $38.90 | $56.23 |
Molina Setting Professional Modifier None Typical Low $26.92 Median $30.20 Typical High $31.62 | Professional | None | $26.92 | $30.20 | $31.62 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $46.77 Median $1,380.38 Typical High $2,238.72 | Facility | None | $46.77 | $1,380.38 | $2,238.72 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $38.90 Median $46.77 Typical High $2,630.27 | Professional | None | $38.90 | $46.77 | $2,630.27 |
Regence BlueShield Setting Professional Modifier None Typical Low $26.30 Median $26.30 Typical High $38.90 | Professional | None | $26.30 | $26.30 | $38.90 |
Select Health Setting Facility Modifier None Typical Low $37.15 Median $37.15 Typical High $43.65 | Facility | None | $37.15 | $37.15 | $43.65 |
Select Health Setting Professional Modifier None Typical Low $37.15 Median $40.74 Typical High $87.10 | Professional | None | $37.15 | $40.74 | $87.10 |
United Setting Professional Modifier None Typical Low $12.02 Median $15.49 Typical High $27.54 | Professional | None | $12.02 | $15.49 | $27.54 |
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 $10.47 Median $24.55 Typical High $24.55 | Professional | 52 · Reduced service | $10.47 | $24.55 | $24.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.17 Median $10.00 Typical High $10.00 | Professional | 53 · Discontinued | $4.17 | $10.00 | $10.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $15.49 Median $37.15 Typical High $37.15 | Professional | 54 · Surgery only | $15.49 | $37.15 | $37.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.09 Median $7.41 Typical High $7.41 | Professional | 55 · Aftercare only | $3.09 | $7.41 | $7.41 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.09 Median $4.90 Typical High $4.90 | Professional | 56 · Pre-op care only | $2.09 | $4.90 | $4.90 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $24.55 Median $27.54 Typical High $28.84 | Professional | 78 · Unplanned return to OR | $24.55 | $27.54 | $28.84 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $10.47 Median $24.55 Typical High $24.55 | Professional | 52 · Reduced service | $10.47 | $24.55 | $24.55 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $4.17 Median $10.00 Typical High $10.00 | Professional | 53 · Discontinued | $4.17 | $10.00 | $10.00 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $15.49 Median $37.15 Typical High $37.15 | Professional | 54 · Surgery only | $15.49 | $37.15 | $37.15 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $3.09 Median $7.41 Typical High $7.41 | Professional | 55 · Aftercare only | $3.09 | $7.41 | $7.41 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $2.09 Median $4.90 Typical High $4.90 | Professional | 56 · Pre-op care only | $2.09 | $4.90 | $4.90 |
Where Idaho sits
The same service costs 3.1 times more in Rhode Island than in New York. 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· 3rd of 51
$38.90
RI $45.71NY $14.79
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.