How much rates vary
Facilitymedian $34 · 10th to 90th $27 to $1,259Professionalmedian $34 · 10th to 90th $14 to $51
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 $19.05 Median $44.67 Typical High $44.67 | Professional | None | $19.05 | $44.67 | $44.67 |
BCBS Idaho Setting Facility Modifier None Typical Low $21.38 Median $31.62 Typical High $53.70 | Facility | None | $21.38 | $31.62 | $53.70 |
BCBS Idaho Setting Professional Modifier None Typical Low $23.44 Median $35.48 Typical High $37.15 | Professional | None | $23.44 | $35.48 | $37.15 |
Cigna Setting Professional Modifier None Typical Low $13.80 Median $13.80 Typical High $13.80 | Professional | None | $13.80 | $13.80 | $13.80 |
Moda Health Setting Facility Modifier None Typical Low $32.36 Median $33.88 Typical High $64.57 | Facility | None | $32.36 | $33.88 | $64.57 |
Moda Health Setting Professional Modifier None Typical Low $19.05 Median $35.48 Typical High $44.67 | Professional | None | $19.05 | $35.48 | $44.67 |
Molina Setting Professional Modifier None Typical Low $24.55 Median $28.84 Typical High $30.20 | Professional | None | $24.55 | $28.84 | $30.20 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $42.66 Median $1,258.93 Typical High $2,041.74 | Facility | None | $42.66 | $1,258.93 | $2,041.74 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $35.48 Median $42.66 Typical High $2,398.83 | Professional | None | $35.48 | $42.66 | $2,398.83 |
Regence BlueShield Setting Professional Modifier None Typical Low $23.44 Median $23.44 Typical High $35.48 | Professional | None | $23.44 | $23.44 | $35.48 |
Select Health Setting Facility Modifier None Typical Low $33.88 Median $33.88 Typical High $39.81 | Facility | None | $33.88 | $33.88 | $39.81 |
Select Health Setting Professional Modifier None Typical Low $33.88 Median $37.15 Typical High $79.43 | Professional | None | $33.88 | $37.15 | $79.43 |
United Setting Professional Modifier None Typical Low $10.96 Median $14.13 Typical High $25.12 | Professional | None | $10.96 | $14.13 | $25.12 |
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 $9.55 Median $22.39 Typical High $22.39 | Professional | 52 · Reduced service | $9.55 | $22.39 | $22.39 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.80 Median $8.91 Typical High $8.91 | Professional | 53 · Discontinued | $3.80 | $8.91 | $8.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $14.13 Median $33.88 Typical High $33.88 | Professional | 54 · Surgery only | $14.13 | $33.88 | $33.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.82 Median $6.76 Typical High $6.76 | Professional | 55 · Aftercare only | $2.82 | $6.76 | $6.76 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.91 Median $4.47 Typical High $4.47 | Professional | 56 · Pre-op care only | $1.91 | $4.47 | $4.47 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $22.39 Median $25.12 Typical High $26.30 | Professional | 78 · Unplanned return to OR | $22.39 | $25.12 | $26.30 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $9.55 Median $22.39 Typical High $22.39 | Professional | 52 · Reduced service | $9.55 | $22.39 | $22.39 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $3.80 Median $8.91 Typical High $8.91 | Professional | 53 · Discontinued | $3.80 | $8.91 | $8.91 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $14.13 Median $33.88 Typical High $33.88 | Professional | 54 · Surgery only | $14.13 | $33.88 | $33.88 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $2.82 Median $6.76 Typical High $6.76 | Professional | 55 · Aftercare only | $2.82 | $6.76 | $6.76 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $1.91 Median $4.47 Typical High $4.47 | Professional | 56 · Pre-op care only | $1.91 | $4.47 | $4.47 |
Where Idaho sits
The same service costs 2.6 times more in Hawaii 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
$33.88
HI $35.48NY $13.49
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.