How much rates vary
Facilitymedian $148 · 10th to 90th $89 to $759Professionalmedian $214 · 10th to 90th $138 to $363
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 $89.13 Median $138.04 Typical High $147.91 | Facility | None | $89.13 | $138.04 | $147.91 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $66.07 Median $66.07 Typical High $112.20 | Facility | 54 · Surgery only | $66.07 | $66.07 | $112.20 |
Aetna Setting Professional Modifier None Typical Low $87.10 Median $134.90 Typical High $169.82 | Professional | None | $87.10 | $134.90 | $169.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $87.10 Typical High $112.20 | Professional | 54 · Surgery only | $63.10 | $87.10 | $112.20 |
BCBS North Dakota Setting Professional Modifier None Typical Low $162.18 Median $229.09 Typical High $363.08 | Professional | None | $162.18 | $229.09 | $363.08 |
BCBS North Dakota Setting Professional Modifier 22 · Increased work Typical Low $194.98 Median $275.42 Typical High $436.52 | Professional | 22 · Increased work | $194.98 | $275.42 | $436.52 |
BCBS North Dakota Setting Professional Modifier 54 · Surgery only Typical Low $114.82 Median $162.18 Typical High $251.19 | Professional | 54 · Surgery only | $114.82 | $162.18 | $251.19 |
BCBS North Dakota Setting Professional Modifier 78 · Unplanned return to OR Typical Low $123.03 Median $173.78 Typical High $269.15 | Professional | 78 · Unplanned return to OR | $123.03 | $173.78 | $269.15 |
Cigna Setting Facility Modifier None Typical Low $234.42 Median $234.42 Typical High $269.15 | Facility | None | $234.42 | $234.42 | $269.15 |
Cigna Setting Professional Modifier None Typical Low $123.03 Median $213.80 Typical High $371.54 | Professional | None | $123.03 | $213.80 | $371.54 |
Medica Setting Facility Modifier None Typical Low $89.13 Median $194.98 Typical High $758.58 | Facility | None | $89.13 | $194.98 | $758.58 |
Medica Setting Professional Modifier None Typical Low $151.36 Median $288.40 Typical High $645.65 | Professional | None | $151.36 | $288.40 | $645.65 |
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 $91.20 Median $173.78 Typical High $309.03 | Professional | None | $91.20 | $173.78 | $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 $43.65 Median $43.65 Typical High $74.13 | Facility | 52 · Reduced service | $43.65 | $43.65 | $74.13 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $17.78 Median $17.78 Typical High $29.51 | Facility | 53 · Discontinued | $17.78 | $17.78 | $29.51 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $13.18 Median $13.18 Typical High $22.39 | Facility | 55 · Aftercare only | $13.18 | $13.18 | $22.39 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $8.91 Median $8.91 Typical High $14.79 | Facility | 56 · Pre-op care only | $8.91 | $8.91 | $14.79 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $42.66 Median $57.54 Typical High $74.13 | Professional | 52 · Reduced service | $42.66 | $57.54 | $74.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $22.91 Typical High $29.51 | Professional | 53 · Discontinued | $16.98 | $22.91 | $29.51 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $17.38 Typical High $22.39 | Professional | 55 · Aftercare only | $12.59 | $17.38 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $11.48 Typical High $14.79 | Professional | 56 · Pre-op care only | $8.51 | $11.48 | $14.79 |
Where North Dakota sits
The same service costs 7.8 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 $2,820ND $362
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.