How much rates vary
Facilitymedian $52 · 10th to 90th $42 to $1,950Professionalmedian $52 · 10th to 90th $21 to $83
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 $29.51 Median $69.18 Typical High $69.18 | Professional | None | $29.51 | $69.18 | $69.18 |
BCBS Idaho Setting Facility Modifier None Typical Low $33.88 Median $48.98 Typical High $83.18 | Facility | None | $33.88 | $48.98 | $83.18 |
BCBS Idaho Setting Professional Modifier None Typical Low $37.15 Median $54.95 Typical High $57.54 | Professional | None | $37.15 | $54.95 | $57.54 |
Cigna Setting Professional Modifier None Typical Low $21.38 Median $21.38 Typical High $21.38 | Professional | None | $21.38 | $21.38 | $21.38 |
Moda Health Setting Facility Modifier None Typical Low $50.12 Median $52.48 Typical High $100.00 | Facility | None | $50.12 | $52.48 | $100.00 |
Moda Health Setting Professional Modifier None Typical Low $34.67 Median $54.95 Typical High $72.44 | Professional | None | $34.67 | $54.95 | $72.44 |
Molina Setting Professional Modifier None Typical Low $30.20 Median $38.02 Typical High $44.67 | Professional | None | $30.20 | $38.02 | $44.67 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $66.07 Median $1,949.84 Typical High $3,162.28 | Facility | None | $66.07 | $1,949.84 | $3,162.28 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $54.95 Median $66.07 Typical High $3,715.35 | Professional | None | $54.95 | $66.07 | $3,715.35 |
Regence BlueShield Setting Professional Modifier None Typical Low $37.15 Median $37.15 Typical High $54.95 | Professional | None | $37.15 | $37.15 | $54.95 |
Select Health Setting Facility Modifier None Typical Low $52.48 Median $52.48 Typical High $61.66 | Facility | None | $52.48 | $52.48 | $61.66 |
Select Health Setting Professional Modifier None Typical Low $52.48 Median $57.54 Typical High $123.03 | Professional | None | $52.48 | $57.54 | $123.03 |
United Setting Professional Modifier None Typical Low $16.98 Median $21.88 Typical High $38.90 | Professional | None | $16.98 | $21.88 | $38.90 |
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 $14.79 Median $34.67 Typical High $34.67 | Professional | 52 · Reduced service | $14.79 | $34.67 | $34.67 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.89 Median $14.13 Typical High $14.13 | Professional | 53 · Discontinued | $5.89 | $14.13 | $14.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $21.88 Median $52.48 Typical High $52.48 | Professional | 54 · Surgery only | $21.88 | $52.48 | $52.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.37 Median $10.47 Typical High $10.47 | Professional | 55 · Aftercare only | $4.37 | $10.47 | $10.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.95 Median $6.92 Typical High $6.92 | Professional | 56 · Pre-op care only | $2.95 | $6.92 | $6.92 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $34.67 Median $38.90 Typical High $40.74 | Professional | 78 · Unplanned return to OR | $34.67 | $38.90 | $40.74 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $14.79 Median $34.67 Typical High $34.67 | Professional | 52 · Reduced service | $14.79 | $34.67 | $34.67 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $5.89 Median $14.13 Typical High $14.13 | Professional | 53 · Discontinued | $5.89 | $14.13 | $14.13 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $21.88 Median $52.48 Typical High $52.48 | Professional | 54 · Surgery only | $21.88 | $52.48 | $52.48 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $4.37 Median $10.47 Typical High $10.47 | Professional | 55 · Aftercare only | $4.37 | $10.47 | $10.47 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $2.95 Median $6.92 Typical High $6.92 | Professional | 56 · Pre-op care only | $2.95 | $6.92 | $6.92 |
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· 5th of 51
$52.48
HI $54.95NY $20.89
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.