How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $107.15 Median $107.15 Typical High $5,754.40 | Facility | None | $107.15 | $107.15 | $5,754.40 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $107.15 Typical High $239.88 | Professional | None | $91.20 | $107.15 | $239.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $79.43 Typical High $89.13 | Professional | 54 · Surgery only | $69.18 | $79.43 | $89.13 |
BCBS North Dakota Setting Professional Modifier None Typical Low $162.18 Median $213.80 Typical High $251.19 | Professional | None | $162.18 | $213.80 | $251.19 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $194.98 Median $257.04 Typical High $302.00 | Professional | 22 · Increased work | $194.98 | $257.04 | $302.00 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $114.82 Median $147.91 Typical High $177.83 | Professional | 54 · Surgery only | $114.82 | $147.91 | $177.83 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $123.03 Median $158.49 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $123.03 | $158.49 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $165.96 Typical High $288.40 | Professional | None | $104.71 | $165.96 | $288.40 |
Medica Setting Facility Modifier None Typical Low $107.15 Median $107.15 Typical High $316.23 | Facility | None | $107.15 | $107.15 | $316.23 |
Medica Setting Professional Modifier None Typical Low $112.20 Median $213.80 Typical High $776.25 | Professional | None | $112.20 | $213.80 | $776.25 |
United Setting Professional Modifier None Typical Low $112.20 Median $186.21 Typical High $234.42 | Professional | None | $112.20 | $186.21 | $234.42 |
4 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 $45.71 Median $53.70 Typical High $60.26 | Professional | 52 · Reduced service | $45.71 | $53.70 | $60.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $21.38 Typical High $23.99 | Professional | 53 · Discontinued | $18.20 | $21.38 | $23.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.80 Median $15.85 Typical High $17.78 | Professional | 55 · Aftercare only | $13.80 | $15.85 | $17.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $10.72 Typical High $12.02 | Professional | 56 · Pre-op care only | $9.12 | $10.72 | $12.02 |
Where North Dakota sits
The same service costs 3.5 times more in Wisconsin 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.
North Dakota· 9th of 51
$191
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.