How much rates vary
Facilitymedian $3,388 · 10th to 90th $813 to $9,550Professionalmedian $1,738 · 10th to 90th $1,349 to $2,239
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 $1,412.54 Median $1,737.80 Typical High $1,737.80 | Professional | None | $1,412.54 | $1,737.80 | $1,737.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,288.25 Median $1,288.25 Typical High $1,288.25 | Professional | 54 · Surgery only | $1,288.25 | $1,288.25 | $1,288.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $257.04 Typical High $257.04 | Professional | 55 · Aftercare only | $257.04 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | 56 · Pre-op care only | $173.78 | $173.78 | $173.78 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $1,548.82 Median $1,819.70 Typical High $1,819.70 | Professional | None | $1,548.82 | $1,819.70 | $1,819.70 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $891.25 Median $1,258.93 Typical High $1,479.11 | Professional | 54 · Surgery only | $891.25 | $1,258.93 | $1,479.11 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $154.88 Typical High $181.97 | Professional | 55 · Aftercare only | $109.65 | $154.88 | $181.97 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $97.72 Median $141.25 Typical High $165.96 | Professional | 56 · Pre-op care only | $97.72 | $141.25 | $165.96 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $676.08 Typical High $1,202.26 | Facility | None | $50.12 | $676.08 | $1,202.26 |
Cigna Setting Professional Modifier None Typical Low $2,187.76 Median $2,238.72 Typical High $2,238.72 | Professional | None | $2,187.76 | $2,238.72 | $2,238.72 |
United Setting Facility Modifier None Typical Low $933.25 Median $3,388.44 Typical High $10,232.93 | Facility | None | $933.25 | $3,388.44 | $10,232.93 |
United Setting Professional Modifier None Typical Low $1,258.93 Median $1,412.54 Typical High $2,041.74 | Professional | None | $1,258.93 | $1,412.54 | $2,041.74 |
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 $851.14 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $851.14 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $346.74 Median $346.74 Typical High $346.74 | Professional | 53 · Discontinued | $346.74 | $346.74 | $346.74 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $1,202.26 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $1,202.26 | $1,202.26 | $1,202.26 |
Where Rhode Island sits
The same service costs 8.5 times more in Maine than in Delaware. 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
ME $28,081DE $3,299
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.