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 $169.82 Median $251.19 Typical High $263.03 | Facility | None | $169.82 | $251.19 | $263.03 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $128.82 Median $128.82 Typical High $199.53 | Facility | 54 · Surgery only | $128.82 | $128.82 | $199.53 |
Aetna Setting Facility Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $120.23 Typical High $186.21 | Facility | 78 · Unplanned return to OR | $120.23 | $120.23 | $186.21 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $251.19 Typical High $288.40 | Professional | None | $169.82 | $251.19 | $288.40 |
BCBS North Dakota Setting Professional Modifier None Typical Low $309.03 Median $416.87 Typical High $616.60 | Professional | None | $309.03 | $416.87 | $616.60 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $363.08 Median $501.19 Typical High $741.31 | Professional | 22 · Increased work | $363.08 | $501.19 | $741.31 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $213.80 Median $295.12 Typical High $426.58 | Professional | 54 · Surgery only | $213.80 | $295.12 | $426.58 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $229.09 Median $316.23 Typical High $457.09 | Professional | 78 · Unplanned return to OR | $229.09 | $316.23 | $457.09 |
Cigna Setting Facility Modifier None Typical Low $446.68 Median $446.68 Typical High $512.86 | Facility | None | $446.68 | $446.68 | $512.86 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $436.52 Typical High $812.83 | Professional | None | $281.84 | $436.52 | $812.83 |
Medica Setting Facility Modifier None Typical Low $169.82 Median $363.08 Typical High $1,698.24 | Facility | None | $169.82 | $363.08 | $1,698.24 |
Medica Setting Professional Modifier None Typical Low $269.15 Median $489.78 Typical High $575.44 | Professional | None | $269.15 | $489.78 | $575.44 |
United Setting Facility Modifier None Typical Low $758.58 Median $1,023.29 Typical High $1,698.24 | Facility | None | $758.58 | $1,023.29 | $1,698.24 |
United Setting Professional Modifier None Typical Low $173.78 Median $331.13 Typical High $549.54 | Professional | None | $173.78 | $331.13 | $549.54 |
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 Facility Modifier 52 · Reduced service Typical Low $85.11 Median $85.11 Typical High $131.83 | Facility | 52 · Reduced service | $85.11 | $85.11 | $131.83 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $33.88 Median $33.88 Typical High $52.48 | Facility | 53 · Discontinued | $33.88 | $33.88 | $52.48 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $25.70 Median $25.70 Typical High $39.81 | Facility | 55 · Aftercare only | $25.70 | $25.70 | $39.81 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $16.98 Median $16.98 Typical High $26.30 | Facility | 56 · Pre-op care only | $16.98 | $16.98 | $26.30 |
Where North Dakota sits
The same service costs 4.3 times more in Wisconsin than in Kentucky. 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· 13th of 51
$372
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.