How much rates vary
Facilitymedian $158 · 10th to 90th $40 to $759Professionalmedian $158 · 10th to 90th $54 to $398
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 $39.81 Median $154.88 Typical High $158.49 | Facility | None | $39.81 | $154.88 | $158.49 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $30.20 Median $30.20 Typical High $120.23 | Facility | 54 · Surgery only | $30.20 | $30.20 | $120.23 |
Aetna Setting Professional Modifier None Typical Low $39.81 Median $151.36 Typical High $162.18 | Professional | None | $39.81 | $151.36 | $162.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $30.20 Median $112.20 Typical High $120.23 | Professional | 54 · Surgery only | $30.20 | $112.20 | $120.23 |
BCBS North Dakota Setting Professional Modifier None Typical Low $75.86 Median $114.82 Typical High $407.38 | Professional | None | $75.86 | $114.82 | $407.38 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $91.20 Median $138.04 Typical High $489.78 | Professional | 22 · Increased work | $91.20 | $138.04 | $489.78 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $52.48 Median $81.28 Typical High $281.84 | Professional | 54 · Surgery only | $52.48 | $81.28 | $281.84 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $56.23 Median $87.10 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $56.23 | $87.10 | $302.00 |
Cigna Setting Facility Modifier None Typical Low $281.84 Median $281.84 Typical High $323.59 | Facility | None | $281.84 | $281.84 | $323.59 |
Cigna Setting Professional Modifier None Typical Low $53.70 Median $138.04 Typical High $407.38 | Professional | None | $53.70 | $138.04 | $407.38 |
Medica Setting Facility Modifier None Typical Low $39.81 Median $158.49 Typical High $660.69 | Facility | None | $39.81 | $158.49 | $660.69 |
Medica Setting Professional Modifier None Typical Low $131.83 Median $281.84 Typical High $1,202.26 | Professional | None | $131.83 | $281.84 | $1,202.26 |
United Setting Facility Modifier None Typical Low $446.68 Median $616.60 Typical High $758.58 | Facility | None | $446.68 | $616.60 | $758.58 |
United Setting Professional Modifier None Typical Low $38.02 Median $107.15 Typical High $302.00 | Professional | None | $38.02 | $107.15 | $302.00 |
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 $19.95 Median $19.95 Typical High $79.43 | Facility | 52 · Reduced service | $19.95 | $19.95 | $79.43 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $7.94 Median $7.94 Typical High $31.62 | Facility | 53 · Discontinued | $7.94 | $7.94 | $31.62 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $6.03 Median $6.03 Typical High $23.99 | Facility | 55 · Aftercare only | $6.03 | $6.03 | $23.99 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $3.98 Median $3.98 Typical High $15.85 | Facility | 56 · Pre-op care only | $3.98 | $3.98 | $15.85 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $19.95 Median $75.86 Typical High $81.28 | Professional | 52 · Reduced service | $19.95 | $75.86 | $81.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $30.20 Typical High $32.36 | Professional | 53 · Discontinued | $7.94 | $30.20 | $32.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.03 Median $22.39 Typical High $24.55 | Professional | 55 · Aftercare only | $6.03 | $22.39 | $24.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.98 Median $15.14 Typical High $16.22 | Professional | 56 · Pre-op care only | $3.98 | $15.14 | $16.22 |
Where North Dakota sits
The same service costs 4.6 times more in Wisconsin than in Washington, DC. 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
$158
WI $240DC $52.48
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.