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 $112.20 Median $151.36 Typical High $151.36 | Facility | None | $112.20 | $151.36 | $151.36 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $85.11 Median $85.11 Typical High $112.20 | Facility | 54 · Surgery only | $85.11 | $85.11 | $112.20 |
Aetna Setting Facility Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $79.43 Typical High $104.71 | Facility | 78 · Unplanned return to OR | $79.43 | $79.43 | $104.71 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $134.90 Typical High $165.96 | Professional | None | $104.71 | $134.90 | $165.96 |
BCBS North Dakota Setting Professional Modifier None Typical Low $204.17 Median $288.40 Typical High $398.11 | Professional | None | $204.17 | $288.40 | $398.11 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $245.47 Median $346.74 Typical High $478.63 | Professional | 22 · Increased work | $245.47 | $346.74 | $478.63 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $199.53 Typical High $275.42 | Professional | 54 · Surgery only | $141.25 | $199.53 | $275.42 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $151.36 Median $213.80 Typical High $295.12 | Professional | 78 · Unplanned return to OR | $151.36 | $213.80 | $295.12 |
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 $181.97 Median $288.40 Typical High $512.86 | Professional | None | $181.97 | $288.40 | $512.86 |
Medica Setting Facility Modifier None Typical Low $112.20 Median $199.53 Typical High $2,454.71 | Facility | None | $112.20 | $199.53 | $2,454.71 |
Medica Setting Professional Modifier None Typical Low $154.88 Median $245.47 Typical High $323.59 | Professional | None | $154.88 | $245.47 | $323.59 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,344.23 Typical High $2,630.27 | Facility | None | $1,513.56 | $2,344.23 | $2,630.27 |
United Setting Professional Modifier None Typical Low $117.49 Median $208.93 Typical High $281.84 | Professional | None | $117.49 | $208.93 | $281.84 |
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 $56.23 Median $56.23 Typical High $75.86 | Facility | 52 · Reduced service | $56.23 | $56.23 | $75.86 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $22.39 Median $22.39 Typical High $30.20 | Facility | 53 · Discontinued | $22.39 | $22.39 | $30.20 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $16.98 Median $16.98 Typical High $22.39 | Facility | 55 · Aftercare only | $16.98 | $16.98 | $22.39 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $11.22 Median $11.22 Typical High $15.14 | Facility | 56 · Pre-op care only | $11.22 | $11.22 | $15.14 |
Where North Dakota sits
The same service costs 3.6 times more in Wisconsin than in Texas. 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· 9th of 51
$245
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.