How much rates vary
Facilitymedian $15 · 10th to 90th $11 to $575Professionalmedian $16 · 10th to 90th $6 to $30
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 $10.00 Median $10.00 Typical High $10.00 | Facility | None | $10.00 | $10.00 | $10.00 |
Aetna Setting Professional Modifier None Typical Low $8.71 Median $20.42 Typical High $20.42 | Professional | None | $8.71 | $20.42 | $20.42 |
BCBS Idaho Setting Facility Modifier None Typical Low $10.72 Median $14.45 Typical High $24.55 | Facility | None | $10.72 | $14.45 | $24.55 |
BCBS Idaho Setting Professional Modifier None Typical Low $10.96 Median $16.22 Typical High $16.98 | Professional | None | $10.96 | $16.22 | $16.98 |
Cigna Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $6.31 | Professional | None | $6.31 | $6.31 | $6.31 |
Moda Health Setting Facility Modifier None Typical Low $10.00 Median $15.49 Typical High $45.71 | Facility | None | $10.00 | $15.49 | $45.71 |
Moda Health Setting Professional Modifier None Typical Low $11.22 Median $16.22 Typical High $20.42 | Professional | None | $11.22 | $16.22 | $20.42 |
Molina Setting Professional Modifier None Typical Low $11.22 Median $13.18 Typical High $30.20 | Professional | None | $11.22 | $13.18 | $30.20 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $19.50 Median $575.44 Typical High $933.25 | Facility | None | $19.50 | $575.44 | $933.25 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $16.22 Median $19.50 Typical High $1,096.48 | Professional | None | $16.22 | $19.50 | $1,096.48 |
Regence BlueShield Setting Professional Modifier None Typical Low $10.96 Median $10.96 Typical High $16.22 | Professional | None | $10.96 | $10.96 | $16.22 |
Select Health Setting Facility Modifier None Typical Low $15.49 Median $15.49 Typical High $18.20 | Facility | None | $15.49 | $15.49 | $18.20 |
Select Health Setting Professional Modifier None Typical Low $15.49 Median $16.98 Typical High $36.31 | Professional | None | $15.49 | $16.98 | $36.31 |
United Setting Professional Modifier None Typical Low $5.01 Median $6.46 Typical High $11.48 | Professional | None | $5.01 | $6.46 | $11.48 |
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 $4.37 Median $10.23 Typical High $10.23 | Professional | 52 · Reduced service | $4.37 | $10.23 | $10.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.74 Median $4.07 Typical High $4.07 | Professional | 53 · Discontinued | $1.74 | $4.07 | $4.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $6.46 Median $15.49 Typical High $15.49 | Professional | 54 · Surgery only | $6.46 | $15.49 | $15.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.29 Median $3.09 Typical High $3.09 | Professional | 55 · Aftercare only | $1.29 | $3.09 | $3.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.87 Median $2.04 Typical High $2.04 | Professional | 56 · Pre-op care only | $0.87 | $2.04 | $2.04 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $10.23 Median $11.48 Typical High $12.02 | Professional | 78 · Unplanned return to OR | $10.23 | $11.48 | $12.02 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $4.37 Median $10.23 Typical High $10.23 | Professional | 52 · Reduced service | $4.37 | $10.23 | $10.23 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $1.74 Median $4.07 Typical High $4.07 | Professional | 53 · Discontinued | $1.74 | $4.07 | $4.07 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $6.46 Median $15.49 Typical High $15.49 | Professional | 54 · Surgery only | $6.46 | $15.49 | $15.49 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $1.29 Median $3.09 Typical High $3.09 | Professional | 55 · Aftercare only | $1.29 | $3.09 | $3.09 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.87 Median $2.04 Typical High $2.04 | Professional | 56 · Pre-op care only | $0.87 | $2.04 | $2.04 |
Where Idaho sits
The same service costs 4.5 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
$16.22
RI $27.54NY $6.17
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.