How much rates vary
Facilitymedian $138 · 10th to 90th $49 to $417Professionalmedian $151 · 10th to 90th $63 to $347
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 $48.98 Median $128.82 Typical High $138.04 | Facility | None | $48.98 | $128.82 | $138.04 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $36.31 Median $38.90 Typical High $104.71 | Facility | 54 · Surgery only | $36.31 | $38.90 | $104.71 |
Aetna Setting Professional Modifier None Typical Low $48.98 Median $123.03 Typical High $245.47 | Professional | None | $48.98 | $123.03 | $245.47 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $36.31 Median $64.57 Typical High $112.20 | Professional | 54 · Surgery only | $36.31 | $64.57 | $112.20 |
BCBS North Dakota Setting Professional Modifier None Typical Low $83.18 Median $131.83 Typical High $275.42 | Professional | None | $83.18 | $131.83 | $275.42 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $100.00 Median $158.49 Typical High $331.13 | Professional | 22 · Increased work | $100.00 | $158.49 | $331.13 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $93.33 Typical High $190.55 | Professional | 54 · Surgery only | $57.54 | $93.33 | $190.55 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $61.66 Median $100.00 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $61.66 | $100.00 | $204.17 |
Cigna Setting Professional Modifier None Typical Low $60.26 Median $134.90 Typical High $309.03 | Professional | None | $60.26 | $134.90 | $309.03 |
Medica Setting Facility Modifier None Typical Low $48.98 Median $138.04 Typical High $2,691.53 | Facility | None | $48.98 | $138.04 | $2,691.53 |
Medica Setting Professional Modifier None Typical Low $151.36 Median $436.52 Typical High $1,047.13 | Professional | None | $151.36 | $436.52 | $1,047.13 |
United Setting Professional Modifier None Typical Low $52.48 Median $134.90 Typical High $309.03 | Professional | None | $52.48 | $134.90 | $309.03 |
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 $24.55 Median $25.70 Typical High $69.18 | Facility | 52 · Reduced service | $24.55 | $25.70 | $69.18 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $9.77 Median $10.47 Typical High $28.18 | Facility | 53 · Discontinued | $9.77 | $10.47 | $28.18 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $7.41 Median $7.76 Typical High $20.89 | Facility | 55 · Aftercare only | $7.41 | $7.76 | $20.89 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $4.90 Median $5.25 Typical High $13.80 | Facility | 56 · Pre-op care only | $4.90 | $5.25 | $13.80 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $24.55 Median $42.66 Typical High $74.13 | Professional | 52 · Reduced service | $24.55 | $42.66 | $74.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.77 Median $16.98 Typical High $29.51 | Professional | 53 · Discontinued | $9.77 | $16.98 | $29.51 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.41 Median $12.88 Typical High $22.39 | Professional | 55 · Aftercare only | $7.41 | $12.88 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.90 Median $8.51 Typical High $14.79 | Professional | 56 · Pre-op care only | $4.90 | $8.51 | $14.79 |
Where North Dakota sits
The same service costs 2.8 times more in Wisconsin than in Florida. 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· 14th of 51
$141
WI $234FL $85.11
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.