How much rates vary
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 Facility Modifier None Typical Low $31.62 Median $31.62 Typical High $53.70 | Facility | None | $31.62 | $31.62 | $53.70 |
Aetna Setting Professional Modifier None Typical Low $31.62 Median $39.81 Typical High $56.23 | Professional | None | $31.62 | $39.81 | $56.23 |
BCBS North Dakota Setting Professional Modifier None Typical Low $52.48 Median $81.28 Typical High $131.83 | Professional | None | $52.48 | $81.28 | $131.83 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $63.10 Median $97.72 Typical High $158.49 | Professional | 22 · Increased work | $63.10 | $97.72 | $158.49 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $37.15 Median $56.23 Typical High $93.33 | Professional | 54 · Surgery only | $37.15 | $56.23 | $93.33 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $39.81 Median $60.26 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $39.81 | $60.26 | $100.00 |
Cigna Setting Facility Modifier None Typical Low $97.72 Median $97.72 Typical High $112.20 | Facility | None | $97.72 | $97.72 | $112.20 |
Cigna Setting Professional Modifier None Typical Low $44.67 Median $81.28 Typical High $151.36 | Professional | None | $44.67 | $81.28 | $151.36 |
Medica Setting Facility Modifier None Typical Low $31.62 Median $70.79 Typical High $263.03 | Facility | None | $31.62 | $70.79 | $263.03 |
Medica Setting Professional Modifier None Typical Low $54.95 Median $104.71 Typical High $1,659.59 | Professional | None | $54.95 | $104.71 | $1,659.59 |
United Setting Facility Modifier None Typical Low $125.89 Median $251.19 Typical High $269.15 | Facility | None | $125.89 | $251.19 | $269.15 |
United Setting Professional Modifier None Typical Low $33.88 Median $63.10 Typical High $104.71 | Professional | None | $33.88 | $63.10 | $104.71 |
8 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 Facility Modifier 52 · Reduced service Typical Low $15.85 Median $15.85 Typical High $26.92 | Facility | 52 · Reduced service | $15.85 | $15.85 | $26.92 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $6.31 Median $6.31 Typical High $10.72 | Facility | 53 · Discontinued | $6.31 | $6.31 | $10.72 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $4.79 Median $4.79 Typical High $7.94 | Facility | 55 · Aftercare only | $4.79 | $4.79 | $7.94 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $3.16 Median $3.16 Typical High $5.37 | Facility | 56 · Pre-op care only | $3.16 | $3.16 | $5.37 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $15.85 Median $19.95 Typical High $28.18 | Professional | 52 · Reduced service | $15.85 | $19.95 | $28.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.31 Median $8.13 Typical High $11.22 | Professional | 53 · Discontinued | $6.31 | $8.13 | $11.22 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.79 Median $6.03 Typical High $8.51 | Professional | 55 · Aftercare only | $4.79 | $6.03 | $8.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.16 Median $3.98 Typical High $5.62 | Professional | 56 · Pre-op care only | $3.16 | $3.98 | $5.62 |
Where North Dakota sits
The same service costs 3.6 times more in Alaska than in Virginia. 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· 10th of 51
$70.79
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.