How much rates vary
Facilitymedian $151 · 10th to 90th $85 to $1,738Professionalmedian $195 · 10th to 90th $117 to $339
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 $151.36 Typical High $1,737.80 | Facility | None | $85.11 | $151.36 | $1,737.80 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $63.10 Median $63.10 Typical High $112.20 | Facility | 54 · Surgery only | $63.10 | $63.10 | $112.20 |
Aetna Setting Professional Modifier None Typical Low $79.43 Median $131.83 Typical High $199.53 | Professional | None | $79.43 | $131.83 | $199.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $81.28 Typical High $112.20 | Professional | 54 · Surgery only | $61.66 | $81.28 | $112.20 |
BCBS North Dakota Setting Professional Modifier None Typical Low $147.91 Median $218.78 Typical High $346.74 | Professional | None | $147.91 | $218.78 | $346.74 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $177.83 Median $263.03 Typical High $416.87 | Professional | 22 · Increased work | $177.83 | $263.03 | $416.87 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $154.88 Typical High $239.88 | Professional | 54 · Surgery only | $102.33 | $154.88 | $239.88 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $109.65 Median $165.96 Typical High $257.04 | Professional | 78 · Unplanned return to OR | $109.65 | $165.96 | $257.04 |
Cigna Setting Facility Modifier None Typical Low $229.09 Median $229.09 Typical High $263.03 | Facility | None | $229.09 | $229.09 | $263.03 |
Cigna Setting Professional Modifier None Typical Low $112.20 Median $204.17 Typical High $363.08 | Professional | None | $112.20 | $204.17 | $363.08 |
Medica Setting Facility Modifier None Typical Low $85.11 Median $186.21 Typical High $758.58 | Facility | None | $85.11 | $186.21 | $758.58 |
Medica Setting Professional Modifier None Typical Low $154.88 Median $295.12 Typical High $588.84 | Professional | None | $154.88 | $295.12 | $588.84 |
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 $87.10 Median $169.82 Typical High $309.03 | Professional | None | $87.10 | $169.82 | $309.03 |
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 $75.86 | Facility | 52 · Reduced service | $42.66 | $42.66 | $75.86 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $16.98 Median $16.98 Typical High $30.20 | Facility | 53 · Discontinued | $16.98 | $16.98 | $30.20 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $12.88 Median $12.88 Typical High $22.91 | Facility | 55 · Aftercare only | $12.88 | $12.88 | $22.91 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $8.51 Median $8.51 Typical High $15.14 | Facility | 56 · Pre-op care only | $8.51 | $8.51 | $15.14 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $41.69 Median $53.70 Typical High $75.86 | Professional | 52 · Reduced service | $41.69 | $53.70 | $75.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $21.38 Typical High $30.20 | Professional | 53 · Discontinued | $16.60 | $21.38 | $30.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $16.22 Typical High $22.91 | Professional | 55 · Aftercare only | $12.30 | $16.22 | $22.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $10.72 Typical High $15.14 | Professional | 56 · Pre-op care only | $8.32 | $10.72 | $15.14 |
Where North Dakota sits
The same service costs 8.0 times more in New York than in North Dakota. 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 $2,762ND $346
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.