How much rates vary
Facilitymedian $26 · 10th to 90th $21 to $955Professionalmedian $28 · 10th to 90th $11 to $40
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 $14.79 Median $34.67 Typical High $34.67 | Professional | None | $14.79 | $34.67 | $34.67 |
BCBS Idaho Setting Facility Modifier None Typical Low $16.98 Median $24.55 Typical High $41.69 | Facility | None | $16.98 | $24.55 | $41.69 |
BCBS Idaho Setting Professional Modifier None Typical Low $18.20 Median $27.54 Typical High $28.84 | Professional | None | $18.20 | $27.54 | $28.84 |
Cigna Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $10.72 | Professional | None | $10.72 | $10.72 | $10.72 |
Moda Health Setting Facility Modifier None Typical Low $25.12 Median $26.30 Typical High $50.12 | Facility | None | $25.12 | $26.30 | $50.12 |
Moda Health Setting Professional Modifier None Typical Low $17.38 Median $27.54 Typical High $34.67 | Professional | None | $17.38 | $27.54 | $34.67 |
Molina Setting Professional Modifier None Typical Low $19.05 Median $22.39 Typical High $30.20 | Professional | None | $19.05 | $22.39 | $30.20 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $33.11 Median $954.99 Typical High $1,584.89 | Facility | None | $33.11 | $954.99 | $1,584.89 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $27.54 Median $33.11 Typical High $1,862.09 | Professional | None | $27.54 | $33.11 | $1,862.09 |
Regence BlueShield Setting Professional Modifier None Typical Low $18.20 Median $18.20 Typical High $27.54 | Professional | None | $18.20 | $18.20 | $27.54 |
Select Health Setting Facility Modifier None Typical Low $25.70 Median $26.30 Typical High $30.90 | Facility | None | $25.70 | $26.30 | $30.90 |
Select Health Setting Professional Modifier None Typical Low $26.30 Median $28.84 Typical High $61.66 | Professional | None | $26.30 | $28.84 | $61.66 |
United Setting Professional Modifier None Typical Low $8.51 Median $10.96 Typical High $19.50 | Professional | None | $8.51 | $10.96 | $19.50 |
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 $7.41 Median $17.38 Typical High $17.38 | Professional | 52 · Reduced service | $7.41 | $17.38 | $17.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.95 Median $6.92 Typical High $6.92 | Professional | 53 · Discontinued | $2.95 | $6.92 | $6.92 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.96 Median $26.30 Typical High $26.30 | Professional | 54 · Surgery only | $10.96 | $26.30 | $26.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.19 Median $5.25 Typical High $5.25 | Professional | 55 · Aftercare only | $2.19 | $5.25 | $5.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.48 Median $3.47 Typical High $3.47 | Professional | 56 · Pre-op care only | $1.48 | $3.47 | $3.47 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $16.98 Median $19.50 Typical High $20.42 | Professional | 78 · Unplanned return to OR | $16.98 | $19.50 | $20.42 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $7.41 Median $17.38 Typical High $17.38 | Professional | 52 · Reduced service | $7.41 | $17.38 | $17.38 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $2.95 Median $6.92 Typical High $6.92 | Professional | 53 · Discontinued | $2.95 | $6.92 | $6.92 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $10.96 Median $26.30 Typical High $26.30 | Professional | 54 · Surgery only | $10.96 | $26.30 | $26.30 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $2.19 Median $5.25 Typical High $5.25 | Professional | 55 · Aftercare only | $2.19 | $5.25 | $5.25 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $1.48 Median $3.47 Typical High $3.47 | Professional | 56 · Pre-op care only | $1.48 | $3.47 | $3.47 |
Where Idaho sits
The same service costs 3.5 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· 2nd of 51
$27.54
RI $36.31NY $10.23
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.