How much rates vary
Facilitymedian $269 · 10th to 90th $123 to $372Professionalmedian $302 · 10th to 90th $158 to $708
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 $123.03 Median $257.04 Typical High $269.15 | Facility | None | $123.03 | $257.04 | $269.15 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $91.20 Median $91.20 Typical High $199.53 | Facility | 54 · Surgery only | $91.20 | $91.20 | $199.53 |
Aetna Setting Professional Modifier None Typical Low $112.20 Median $218.78 Typical High $269.15 | Professional | None | $112.20 | $218.78 | $269.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $120.23 Typical High $199.53 | Professional | 54 · Surgery only | $83.18 | $120.23 | $199.53 |
BCBS North Dakota Setting Professional Modifier None Typical Low $204.17 Median $331.13 Typical High $602.56 | Professional | None | $204.17 | $331.13 | $602.56 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $245.47 Median $398.11 Typical High $724.44 | Professional | 22 · Increased work | $245.47 | $398.11 | $724.44 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $229.09 Typical High $426.58 | Professional | 54 · Surgery only | $141.25 | $229.09 | $426.58 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $151.36 Median $245.47 Typical High $457.09 | Professional | 78 · Unplanned return to OR | $151.36 | $245.47 | $457.09 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $295.12 Typical High $645.65 | Professional | None | $138.04 | $295.12 | $645.65 |
Medica Setting Facility Modifier None Typical Low $123.03 Median $269.15 Typical High $457.09 | Facility | None | $123.03 | $269.15 | $457.09 |
Medica Setting Professional Modifier None Typical Low $275.42 Median $758.58 Typical High $2,454.71 | Professional | None | $275.42 | $758.58 | $2,454.71 |
United Setting Professional Modifier None Typical Low $131.83 Median $269.15 Typical High $512.86 | Professional | None | $131.83 | $269.15 | $512.86 |
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 $61.66 Median $61.66 Typical High $134.90 | Facility | 52 · Reduced service | $61.66 | $61.66 | $134.90 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $24.55 Median $24.55 Typical High $53.70 | Facility | 53 · Discontinued | $24.55 | $24.55 | $53.70 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $18.62 Median $18.62 Typical High $39.81 | Facility | 55 · Aftercare only | $18.62 | $18.62 | $39.81 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $12.30 Median $12.30 Typical High $26.92 | Facility | 56 · Pre-op care only | $12.30 | $12.30 | $26.92 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $56.23 Median $81.28 Typical High $134.90 | Professional | 52 · Reduced service | $56.23 | $81.28 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.39 Median $32.36 Typical High $53.70 | Professional | 53 · Discontinued | $22.39 | $32.36 | $53.70 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $23.99 Typical High $39.81 | Professional | 55 · Aftercare only | $16.98 | $23.99 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.22 Median $16.22 Typical High $26.92 | Professional | 56 · Pre-op care only | $11.22 | $16.22 | $26.92 |
Where North Dakota sits
The same service costs 3.4 times more in Alaska than in Virginia. 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· 15th of 51
$295
AK $525VA $155
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.