Commercial healthcare reimbursement in North Dakota
How North Dakota compares with the nation, by payer, specialty and procedure.
North Dakota at a glance
What the data shows
North Dakota ranks 9th of 51 states for commercial reimbursement, with an index of 127 (100 = national median) across 228 procedure codes; the Midwest region averages 115.
Commercial rates in North Dakota run a median 197% of Medicare.
Blue Cross Blue Shield has the highest index in the state (111) and Aetna the lowest (54), a 57-point gap, in the files analyzed.
CPT 88342 (Imhchem/imcytchm 1st antb) is the strongest relative to the national median (208% of it, a 108% premium); CPT 70551 (Mri brain stem w/o dye) has the smallest premium (98% of the national median).
By specialty, North Dakota is strongest for ophthalmology (ranks 6th of 50 states for that specialty) and weakest for gastroenterology (11th of 50).
Against Medicare, gastroenterology has the highest ratio in North Dakota (217% of Medicare) and dermatology the lowest (150%).
Payer ranking in North Dakota
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield | 111 | 1 | 226 | 329 | 315 | |
| UnitedHealthcare | 102 | 2 | 167 | 210 | 219 | |
| Cigna | 81 | 3 | 64 | 71 | 160 | |
| Aetna | 54 | 4 | 139 | 211 | 210 |
Reimbursement index by specialty in North Dakota
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Ophthalmology | 149 | 6 of 50 | 190% | 42 | 34 | |
| Cardiology | 135 | 7 of 51 | 200% | 38 | 30 | |
| Internal medicine | 132 | 8 of 51 | 159% | 25 | 108 | |
| Diagnostic radiology | 119 | 8 of 51 | 191% | 49 | 86 | |
| Urology | 120 | 8 of 50 | 185% | 37 | 21 | |
| Dermatology | 146 | 9 of 50 | 150% | 44 | 24 | |
| Orthopedic surgery | 127 | 9 of 51 | 199% | 39 | 46 | |
| Gastroenterology | 118 | 11 of 50 | 217% | 36 | 20 |
Specialty by payer in North Dakota
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 147 | 66 | 100 | 162 |
| Dermatology | n/a | n/a | n/a | 176 |
| Ophthalmology | 155 | 81 | n/a | 160 |
| Cardiology | 152 | 67 | n/a | 144 |
| Orthopedic surgery | 131 | 70 | n/a | 139 |
| Diagnostic radiology | 115 | 72 | 104 | 141 |
| Urology | n/a | n/a | n/a | 143 |
| Gastroenterology | 151 | n/a | n/a | 129 |
North Dakota compared with Midwest region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| North Dakota | 127 | 9 | 197% | 369 | |
| Iowa | 128 | 8 | 195% | 716 | |
| Minnesota | 126 | 10 | 167% | 853 | |
| South Dakota | 135 | 6 | 202% | 474 | |
| Nebraska | 138 | 4 | 198% | 601 | |
| Ohio | 99 | 27 | 156% | 937 |
Procedures that pay most and least in North Dakota vs the nation
Highest vs national
| Code | North Dakota | National | Gap | Prov. |
|---|---|---|---|---|
| 88342 Imhchem/imcytchm 1st antb | $198 | $95 | +108% | 24 |
| 88312 Special stains group 1 | $196 | $97 | +101% | 44 |
| 93298 Rem interrog dev eval scrms | $105 | $52 | +101% | 30 |
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $227 | $125 | +81% | 24 |
| 92025 Cptrized corneal topography | $71 | $40 | +76% | 33 |
| 77280 Ther rad simulaj field smpl | $520 | $302 | +72% | 24 |
| 88305 Tissue exam by pathologist | $120 | $70 | +72% | 44 |
| 92273 Full field erg w/i&r | $239 | $142 | +68% | 33 |
| 99487 Cplx chrnc care 1st 60 min | $204 | $121 | +68% | 105 |
| 88313 Special stains group 2 | $119 | $71 | +68% | 20 |
| 92242 Fluorescein&icg angiography | $483 | $288 | +68% | 33 |
| 92083 Extended visual field xm | $122 | $73 | +67% | 34 |
| 15823 Blepharp upr eyelid xcsv skn | $1,130 | $677 | +67% | 33 |
| 97110 Therapeutic exercises | $52 | $31 | +65% | 46 |
| 96574 Dbrdmt prmlg les w/pdt | $520 | $315 | +65% | 24 |
Lowest vs national
| Code | North Dakota | National | Gap | Prov. |
|---|---|---|---|---|
| 70551 Mri brain stem w/o dye | $396 | $402 | -2% | 86 |
| 72141 Mri neck spine w/o dye | $392 | $390 | +0% | 86 |
| 51720 Treatment of bladder lesion | $115 | $111 | +4% | 20 |
| 72148 Mri lumbar spine w/o dye | $396 | $382 | +4% | 132 |
| 73221 Mri joint upr extrem w/o dye | $420 | $399 | +5% | 132 |
| 73721 Mri jnt of lwr extre w/o dye | $423 | $399 | +6% | 132 |
| 72131 Ct lumbar spine w/o dye | $263 | $248 | +6% | 86 |
| 72125 Ct neck spine w/o dye | $265 | $249 | +6% | 86 |
| 72197 Mri pelvis w/o & w/dye | $678 | $634 | +7% | 86 |
| 70553 Mri brain stem w/o & w/dye | $642 | $600 | +7% | 86 |
| 64566 Neuroeltrd stim post tibial | $74 | $69 | +7% | 20 |
| 71250 Ct thorax dx c- | $269 | $250 | +7% | 86 |
| 74183 Mri abd w/o cntr flwd cntr | $681 | $634 | +7% | 86 |
| 43235 Egd diagnostic brush wash | $317 | $294 | +8% | 20 |
| 52601 Prostatectomy (turp) | $1,278 | $1,181 | +8% | 20 |
Frequently asked questions
How do commercial reimbursement rates in North Dakota compare with the rest of the country?
North Dakota ranks 9th of 51 states with an index of 127, across 228 procedure codes. Median commercial rates run 197% of the Medicare rate.
Which payer has the highest rates in North Dakota?
In the files we analyzed, Blue Cross Blue Shield has the highest index (111) and Aetna the lowest (54). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in North Dakota?
Ophthalmology ranks 6th of 50 states.
How many providers does this North Dakota page cover?
369 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between North Dakota and the national median?
CPT 88342 (Imhchem/imcytchm 1st antb) is highest relative to the nation at 208% of the national median; CPT 70551 (Mri brain stem w/o dye) is lowest at 98%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your North Dakota contracts
Compare your negotiated rates with these state medians by payer and specialty.