How much rates vary
Facilitymedian $4,467 · 10th to 90th $1,023 to $10,471Professionalmedian $1,413 · 10th to 90th $955 to $1,905
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 $3,467.37 Median $3,715.35 Typical High $3,981.07 | Facility | None | $3,467.37 | $3,715.35 | $3,981.07 |
Aetna Setting Professional Modifier None Typical Low $1,288.25 Median $1,412.54 Typical High $1,905.46 | Professional | None | $1,288.25 | $1,412.54 | $1,905.46 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,071.52 Typical High $1,071.52 | Professional | 54 · Surgery only | $1,071.52 | $1,071.52 | $1,071.52 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $213.80 Typical High $213.80 | Professional | 55 · Aftercare only | $213.80 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | 56 · Pre-op care only | $141.25 | $141.25 | $141.25 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $954.99 Median $1,288.25 Typical High $1,862.09 | Professional | None | $954.99 | $1,288.25 | $1,862.09 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $616.60 Median $758.58 Typical High $891.25 | Professional | 54 · Surgery only | $616.60 | $758.58 | $891.25 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $229.09 Typical High $269.15 | Professional | 55 · Aftercare only | $186.21 | $229.09 | $269.15 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $89.13 Median $109.65 Typical High $128.82 | Professional | 56 · Pre-op care only | $89.13 | $109.65 | $128.82 |
Cigna Setting Facility Modifier None Typical Low $954.99 Median $4,786.30 Typical High $6,918.31 | Facility | None | $954.99 | $4,786.30 | $6,918.31 |
Cigna Setting Professional Modifier None Typical Low $1,621.81 Median $1,905.46 Typical High $2,187.76 | Professional | None | $1,621.81 | $1,905.46 | $2,187.76 |
United Setting Facility Modifier None Typical Low $1,023.29 Median $4,570.88 Typical High $12,882.50 | Facility | None | $1,023.29 | $4,570.88 | $12,882.50 |
United Setting Professional Modifier None Typical Low $870.96 Median $1,230.27 Typical High $1,995.26 | Professional | None | $870.96 | $1,230.27 | $1,995.26 |
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 $707.95 Median $707.95 Typical High $707.95 | Professional | 52 · Reduced service | $707.95 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | 53 · Discontinued | $281.84 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,000.00 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,000.00 | $1,000.00 |
Where Rhode Island sits
The same service costs 4.2 times more in Colorado 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
CO $14,362MT $3,396
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.