How much rates vary
Facilitymedian $4 · 10th to 90th $4 to $158Professionalmedian $5 · 10th to 90th $2 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 Professional Modifier None Typical Low $2.40 Median $5.75 Typical High $5.75 | Professional | None | $2.40 | $5.75 | $5.75 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $1.20 Median $2.88 Typical High $2.88 | Professional | 52 · Reduced service | $1.20 | $2.88 | $2.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.48 Median $1.15 Typical High $1.15 | Professional | 53 · Discontinued | $0.48 | $1.15 | $1.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1.82 Median $4.27 Typical High $4.27 | Professional | 54 · Surgery only | $1.82 | $4.27 | $4.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.36 Median $0.85 Typical High $0.85 | Professional | 55 · Aftercare only | $0.36 | $0.85 | $0.85 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.24 Median $0.58 Typical High $0.58 | Professional | 56 · Pre-op care only | $0.24 | $0.58 | $0.58 |
BCBS Idaho Setting Facility Modifier None Typical Low $3.02 Median $4.07 Typical High $7.24 | Facility | None | $3.02 | $4.07 | $7.24 |
BCBS Idaho Setting Professional Modifier None Typical Low $3.02 Median $4.57 Typical High $4.79 | Professional | None | $3.02 | $4.57 | $4.79 |
Cigna Setting Professional Modifier None Typical Low $1.78 Median $1.78 Typical High $1.78 | Professional | None | $1.78 | $1.78 | $1.78 |
Moda Health Setting Facility Modifier None Typical Low $4.07 Median $4.27 Typical High $8.13 | Facility | None | $4.07 | $4.27 | $8.13 |
Moda Health Setting Professional Modifier None Typical Low $2.95 Median $4.57 Typical High $5.75 | Professional | None | $2.95 | $4.57 | $5.75 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1.20 Median $2.88 Typical High $2.88 | Professional | 52 · Reduced service | $1.20 | $2.88 | $2.88 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.48 Median $1.15 Typical High $1.15 | Professional | 53 · Discontinued | $0.48 | $1.15 | $1.15 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $1.82 Median $4.27 Typical High $4.27 | Professional | 54 · Surgery only | $1.82 | $4.27 | $4.27 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.36 Median $0.85 Typical High $0.85 | Professional | 55 · Aftercare only | $0.36 | $0.85 | $0.85 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.24 Median $0.58 Typical High $0.58 | Professional | 56 · Pre-op care only | $0.24 | $0.58 | $0.58 |
Molina Setting Professional Modifier None Typical Low $3.09 Median $3.63 Typical High $30.20 | Professional | None | $3.09 | $3.63 | $30.20 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $5.37 Median $158.49 Typical High $257.04 | Facility | None | $5.37 | $158.49 | $257.04 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $4.57 Median $5.37 Typical High $302.00 | Professional | None | $4.57 | $5.37 | $302.00 |
Regence BlueShield Setting Professional Modifier None Typical Low $3.02 Median $3.02 Typical High $4.57 | Professional | None | $3.02 | $3.02 | $4.57 |
Select Health Setting Facility Modifier None Typical Low $4.27 Median $4.27 Typical High $5.13 | Facility | None | $4.27 | $4.27 | $5.13 |
Select Health Setting Professional Modifier None Typical Low $4.27 Median $4.68 Typical High $10.00 | Professional | None | $4.27 | $4.68 | $10.00 |
United Setting Professional Modifier None Typical Low $1.41 Median $1.78 Typical High $3.24 | Professional | None | $1.41 | $1.78 | $3.24 |
1 more rate 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 |
|---|---|---|---|---|---|
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2.82 Median $3.16 Typical High $3.31 | Professional | 78 · Unplanned return to OR | $2.82 | $3.16 | $3.31 |
Where Idaho sits
The same service costs 4.0 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
$4.57
RI $6.76NY $1.70
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.