How much rates vary
Facilitymedian $2,399 · 10th to 90th $871 to $5,888Professionalmedian $550 · 10th to 90th $331 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 $407.38 Median $467.74 Typical High $588.84 | Professional | None | $407.38 | $467.74 | $588.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $302.00 Median $354.81 Typical High $446.68 | Professional | 54 · Surgery only | $302.00 | $354.81 | $446.68 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $70.79 Typical High $89.13 | Professional | 55 · Aftercare only | $60.26 | $70.79 | $89.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $46.77 Typical High $58.88 | Professional | 56 · Pre-op care only | $40.74 | $46.77 | $58.88 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $331.13 Median $478.63 Typical High $676.08 | Professional | None | $331.13 | $478.63 | $676.08 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $186.21 Median $275.42 Typical High $398.11 | Professional | 54 · Surgery only | $186.21 | $275.42 | $398.11 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $57.54 Median $85.11 Typical High $120.23 | Professional | 55 · Aftercare only | $57.54 | $85.11 | $120.23 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $26.92 Median $40.74 Typical High $57.54 | Professional | 56 · Pre-op care only | $26.92 | $40.74 | $57.54 |
Cigna Setting Facility Modifier None Typical Low $676.08 Median $2,137.96 Typical High $3,090.30 | Facility | None | $676.08 | $2,137.96 | $3,090.30 |
Cigna Setting Professional Modifier None Typical Low $549.54 Median $645.65 Typical High $870.96 | Professional | None | $549.54 | $645.65 | $870.96 |
United Setting Facility Modifier None Typical Low $870.96 Median $2,089.30 Typical High $7,244.36 | Facility | None | $870.96 | $2,089.30 | $7,244.36 |
United Setting Professional Modifier None Typical Low $275.42 Median $416.87 Typical High $812.83 | Professional | None | $275.42 | $416.87 | $812.83 |
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 $199.53 Median $234.42 Typical High $295.12 | Professional | 52 · Reduced service | $199.53 | $234.42 | $295.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $93.33 Typical High $117.49 | Professional | 53 · Discontinued | $81.28 | $93.33 | $117.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $331.13 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $281.84 | $331.13 | $416.87 |
Where Rhode Island sits
The same service costs 11.0 times more in Vermont than in Montana. 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 $12,892MT $1,170
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.