How much rates vary
Facilitymedian $2,399 · 10th to 90th $871 to $5,888Professionalmedian $525 · 10th to 90th $380 to $871
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 $2,398.83 Median $3,235.94 Typical High $3,981.07 | Facility | None | $2,398.83 | $3,235.94 | $3,981.07 |
Aetna Setting Professional Modifier None Typical Low $416.87 Median $501.19 Typical High $831.76 | Professional | None | $416.87 | $501.19 | $831.76 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $316.23 Median $316.23 Typical High $371.54 | Professional | 54 · Surgery only | $316.23 | $316.23 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $63.10 Median $63.10 Typical High $74.13 | Professional | 55 · Aftercare only | $63.10 | $63.10 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $41.69 Typical High $50.12 | Professional | 56 · Pre-op care only | $41.69 | $41.69 | $50.12 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $426.58 Median $524.81 Typical High $812.83 | Professional | None | $426.58 | $524.81 | $812.83 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $251.19 Median $354.81 Typical High $562.34 | Professional | 54 · Surgery only | $251.19 | $354.81 | $562.34 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $95.50 Typical High $151.36 | Professional | 55 · Aftercare only | $66.07 | $95.50 | $151.36 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $50.12 Typical High $79.43 | Professional | 56 · Pre-op care only | $34.67 | $50.12 | $79.43 |
Cigna Setting Facility Modifier None Typical Low $676.08 Median $2,089.30 Typical High $3,019.95 | Facility | None | $676.08 | $2,089.30 | $3,019.95 |
Cigna Setting Professional Modifier None Typical Low $616.60 Median $851.14 Typical High $977.24 | Professional | None | $616.60 | $851.14 | $977.24 |
United Setting Facility Modifier None Typical Low $870.96 Median $2,089.30 Typical High $7,413.10 | Facility | None | $870.96 | $2,089.30 | $7,413.10 |
United Setting Professional Modifier None Typical Low $354.81 Median $457.09 Typical High $851.14 | Professional | None | $354.81 | $457.09 | $851.14 |
3 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 Professional Modifier 52 · Reduced service Typical Low $208.93 Median $208.93 Typical High $245.47 | Professional | 52 · Reduced service | $208.93 | $208.93 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $83.18 Typical High $100.00 | Professional | 53 · Discontinued | $83.18 | $83.18 | $100.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $295.12 Median $295.12 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $295.12 | $295.12 | $346.74 |
Where Rhode Island sits
The same service costs 7.2 times more in Vermont than in Maine. 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
VT $9,370ME $1,294
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.