How much rates vary
Facilitymedian $158 · 10th to 90th $105 to $275Professionalmedian $240 · 10th to 90th $126 to $389
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 $104.71 Median $154.88 Typical High $158.49 | Facility | None | $104.71 | $154.88 | $158.49 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $77.62 Median $79.43 Typical High $120.23 | Facility | 54 · Surgery only | $77.62 | $79.43 | $120.23 |
Aetna Setting Facility Modifier 78 · Unplanned return to OR Typical Low $72.44 Median $74.13 Typical High $112.20 | Facility | 78 · Unplanned return to OR | $72.44 | $74.13 | $112.20 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $158.49 Typical High $338.84 | Professional | None | $104.71 | $158.49 | $338.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $117.49 Typical High $125.89 | Professional | 54 · Surgery only | $77.62 | $117.49 | $125.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $72.44 Median $109.65 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $72.44 | $109.65 | $117.49 |
BCBS North Dakota Setting Professional Modifier None Typical Low $199.53 Median $281.84 Typical High $389.05 | Professional | None | $199.53 | $281.84 | $389.05 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $239.88 Median $338.84 Typical High $467.74 | Professional | 22 · Increased work | $239.88 | $338.84 | $467.74 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $194.98 Typical High $275.42 | Professional | 54 · Surgery only | $138.04 | $194.98 | $275.42 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $147.91 Median $208.93 Typical High $295.12 | Professional | 78 · Unplanned return to OR | $147.91 | $208.93 | $295.12 |
Cigna Setting Facility Modifier None Typical Low $275.42 Median $275.42 Typical High $323.59 | Facility | None | $275.42 | $275.42 | $323.59 |
Cigna Setting Professional Modifier None Typical Low $125.89 Median $257.04 Typical High $407.38 | Professional | None | $125.89 | $257.04 | $407.38 |
Medica Setting Facility Modifier None Typical Low $104.71 Median $158.49 Typical High $275.42 | Facility | None | $104.71 | $158.49 | $275.42 |
Medica Setting Professional Modifier None Typical Low $134.90 Median $295.12 Typical High $1,202.26 | Professional | None | $134.90 | $295.12 | $1,202.26 |
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 $102.33 Median $190.55 Typical High $316.23 | Professional | None | $102.33 | $190.55 | $316.23 |
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 $52.48 Median $52.48 Typical High $79.43 | Facility | 52 · Reduced service | $52.48 | $52.48 | $79.43 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $20.89 Median $21.38 Typical High $31.62 | Facility | 53 · Discontinued | $20.89 | $21.38 | $31.62 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $15.49 Median $15.85 Typical High $23.99 | Facility | 55 · Aftercare only | $15.49 | $15.85 | $23.99 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $10.47 Median $10.47 Typical High $15.85 | Facility | 56 · Pre-op care only | $10.47 | $10.47 | $15.85 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $52.48 Median $77.62 Typical High $83.18 | Professional | 52 · Reduced service | $52.48 | $77.62 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $30.90 Typical High $33.88 | Professional | 53 · Discontinued | $20.89 | $30.90 | $33.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $23.44 Typical High $25.12 | Professional | 55 · Aftercare only | $15.49 | $23.44 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $15.49 Typical High $16.98 | Professional | 56 · Pre-op care only | $10.47 | $15.49 | $16.98 |
Where North Dakota sits
The same service costs 9.1 times more in New York than in Delaware. 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.
Physician feeFacility fee
NY $2,759DE $302
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.