How much rates vary
Facilitymedian $120 · 10th to 90th $85 to $269Professionalmedian $170 · 10th to 90th $91 to $257
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 $85.11 Median $95.50 Typical High $120.23 | Facility | None | $85.11 | $95.50 | $120.23 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $64.57 Median $64.57 Typical High $91.20 | Facility | 54 · Surgery only | $64.57 | $64.57 | $91.20 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $114.82 Typical High $177.83 | Professional | None | $85.11 | $114.82 | $177.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $64.57 Median $79.43 Typical High $95.50 | Professional | 54 · Surgery only | $64.57 | $79.43 | $95.50 |
BCBS North Dakota Setting Professional Modifier None Typical Low $141.25 Median $186.21 Typical High $251.19 | Professional | None | $141.25 | $186.21 | $251.19 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $169.82 Median $239.88 Typical High $295.12 | Professional | 22 · Increased work | $169.82 | $239.88 | $295.12 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $125.89 Typical High $165.96 | Professional | 54 · Surgery only | $97.72 | $125.89 | $165.96 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $141.25 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $104.71 | $141.25 | $186.21 |
Cigna Setting Facility Modifier None Typical Low $169.82 Median $169.82 Typical High $194.98 | Facility | None | $169.82 | $169.82 | $194.98 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $173.78 Typical High $269.15 | Professional | None | $93.33 | $173.78 | $269.15 |
Medica Setting Facility Modifier None Typical Low $85.11 Median $125.89 Typical High $263.03 | Facility | None | $85.11 | $125.89 | $263.03 |
Medica Setting Professional Modifier None Typical Low $93.33 Median $223.87 Typical High $812.83 | Professional | None | $93.33 | $223.87 | $812.83 |
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 $75.86 Median $144.54 Typical High $239.88 | Professional | None | $75.86 | $144.54 | $239.88 |
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 $42.66 Median $42.66 Typical High $60.26 | Facility | 52 · Reduced service | $42.66 | $42.66 | $60.26 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $16.98 Median $16.98 Typical High $24.55 | Facility | 53 · Discontinued | $16.98 | $16.98 | $24.55 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $12.88 Median $12.88 Typical High $18.20 | Facility | 55 · Aftercare only | $12.88 | $12.88 | $18.20 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $8.51 Median $8.51 Typical High $12.02 | Facility | 56 · Pre-op care only | $8.51 | $8.51 | $12.02 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $42.66 Median $52.48 Typical High $63.10 | Professional | 52 · Reduced service | $42.66 | $52.48 | $63.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $20.89 Typical High $25.12 | Professional | 53 · Discontinued | $16.98 | $20.89 | $25.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $15.85 Typical High $19.05 | Professional | 55 · Aftercare only | $12.88 | $15.85 | $19.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $10.47 Typical High $12.59 | Professional | 56 · Pre-op care only | $8.51 | $10.47 | $12.59 |
Where North Dakota sits
The same service costs 15.4 times more in Hawaii 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
HI $2,947DE $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.