How much rates vary
Facilitymedian $1,202 · 10th to 90th $372 to $6,457Professionalmedian $1,950 · 10th to 90th $1,479 to $2,570
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 $3,715.35 Median $3,715.35 Typical High $3,981.07 | Facility | None | $3,715.35 | $3,715.35 | $3,981.07 |
Aetna Setting Professional Modifier None Typical Low $1,905.46 Median $1,949.84 Typical High $1,949.84 | Professional | None | $1,905.46 | $1,949.84 | $1,949.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,445.44 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,445.44 | $1,445.44 | $1,445.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $288.40 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $194.98 Typical High $194.98 | Professional | 56 · Pre-op care only | $194.98 | $194.98 | $194.98 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $1,737.80 Median $2,041.74 Typical High $2,041.74 | Professional | None | $1,737.80 | $2,041.74 | $2,041.74 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,412.54 Typical High $1,659.59 | Professional | 54 · Surgery only | $1,000.00 | $1,412.54 | $1,659.59 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $123.03 Median $173.78 Typical High $204.17 | Professional | 55 · Aftercare only | $123.03 | $173.78 | $204.17 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $158.49 Typical High $186.21 | Professional | 56 · Pre-op care only | $109.65 | $158.49 | $186.21 |
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 $2,454.71 Median $2,570.40 Typical High $2,570.40 | Professional | None | $2,454.71 | $2,570.40 | $2,570.40 |
United Setting Facility Modifier None Typical Low $426.58 Median $1,513.56 Typical High $6,456.54 | Facility | None | $426.58 | $1,513.56 | $6,456.54 |
United Setting Professional Modifier None Typical Low $1,412.54 Median $1,584.89 Typical High $2,290.87 | Professional | None | $1,412.54 | $1,584.89 | $2,290.87 |
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 $954.99 Median $954.99 Typical High $954.99 | Professional | 52 · Reduced service | $954.99 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $389.05 Typical High $389.05 | Professional | 53 · Discontinued | $389.05 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,348.96 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,348.96 | $1,348.96 |
Where Rhode Island sits
The same service costs 8.2 times more in Maine than in Maryland. 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 $17,891MD $2,184
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.