How much rates vary
Facilitymedian $12 · 10th to 90th $10 to $437Professionalmedian $13 · 10th to 90th $5 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 $6.61 Median $15.85 Typical High $15.85 | Professional | None | $6.61 | $15.85 | $15.85 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $3.31 Median $7.94 Typical High $7.94 | Professional | 52 · Reduced service | $3.31 | $7.94 | $7.94 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.32 Median $3.16 Typical High $3.16 | Professional | 53 · Discontinued | $1.32 | $3.16 | $3.16 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $5.01 Median $11.75 Typical High $11.75 | Professional | 54 · Surgery only | $5.01 | $11.75 | $11.75 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.00 Median $2.40 Typical High $2.40 | Professional | 55 · Aftercare only | $1.00 | $2.40 | $2.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.68 Median $1.58 Typical High $1.58 | Professional | 56 · Pre-op care only | $0.68 | $1.58 | $1.58 |
BCBS Idaho Setting Facility Modifier None Typical Low $8.32 Median $11.22 Typical High $19.95 | Facility | None | $8.32 | $11.22 | $19.95 |
BCBS Idaho Setting Professional Modifier None Typical Low $8.32 Median $12.59 Typical High $13.18 | Professional | None | $8.32 | $12.59 | $13.18 |
Cigna Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | None | $4.90 | $4.90 | $4.90 |
Moda Health Setting Facility Modifier None Typical Low $11.22 Median $12.02 Typical High $22.91 | Facility | None | $11.22 | $12.02 | $22.91 |
Moda Health Setting Professional Modifier None Typical Low $6.61 Median $12.59 Typical High $15.85 | Professional | None | $6.61 | $12.59 | $15.85 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $3.31 Median $7.94 Typical High $7.94 | Professional | 52 · Reduced service | $3.31 | $7.94 | $7.94 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $1.32 Median $3.16 Typical High $3.16 | Professional | 53 · Discontinued | $1.32 | $3.16 | $3.16 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $5.01 Median $11.75 Typical High $11.75 | Professional | 54 · Surgery only | $5.01 | $11.75 | $11.75 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $1.00 Median $2.40 Typical High $2.40 | Professional | 55 · Aftercare only | $1.00 | $2.40 | $2.40 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.68 Median $1.58 Typical High $1.58 | Professional | 56 · Pre-op care only | $0.68 | $1.58 | $1.58 |
Molina Setting Professional Modifier None Typical Low $8.51 Median $10.00 Typical High $30.20 | Professional | None | $8.51 | $10.00 | $30.20 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $14.79 Median $436.52 Typical High $707.95 | Facility | None | $14.79 | $436.52 | $707.95 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $12.59 Median $14.79 Typical High $831.76 | Professional | None | $12.59 | $14.79 | $831.76 |
Regence BlueShield Setting Professional Modifier None Typical Low $8.32 Median $8.32 Typical High $12.59 | Professional | None | $8.32 | $8.32 | $12.59 |
Select Health Setting Facility Modifier None Typical Low $11.75 Median $12.02 Typical High $14.13 | Facility | None | $11.75 | $12.02 | $14.13 |
Select Health Setting Professional Modifier None Typical Low $12.02 Median $12.88 Typical High $27.54 | Professional | None | $12.02 | $12.88 | $27.54 |
United Setting Professional Modifier None Typical Low $3.89 Median $4.90 Typical High $8.91 | Professional | None | $3.89 | $4.90 | $8.91 |
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 $7.76 Median $8.71 Typical High $9.12 | Professional | 78 · Unplanned return to OR | $7.76 | $8.71 | $9.12 |
Where Idaho sits
The same service costs 2.9 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
$12.59
RI $13.49NY $4.68
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.