How much rates vary
Facilitymedian $1,202 · 10th to 90th $372 to $6,457Professionalmedian $1,318 · 10th to 90th $977 to $1,778
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 $1,318.26 Median $1,318.26 Typical High $1,318.26 | Professional | None | $1,318.26 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $1,000.00 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $199.53 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $131.83 | $131.83 | $131.83 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $891.25 Median $1,174.90 Typical High $1,995.26 | Professional | None | $891.25 | $1,174.90 | $1,995.26 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $831.76 Typical High $1,412.54 | Professional | 54 · Surgery only | $588.84 | $831.76 | $1,412.54 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $63.10 Median $91.20 Typical High $151.36 | Professional | 55 · Aftercare only | $63.10 | $91.20 | $151.36 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $56.23 Median $81.28 Typical High $134.90 | Professional | 56 · Pre-op care only | $56.23 | $81.28 | $134.90 |
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 $1,258.93 Median $1,778.28 Typical High $2,041.74 | Professional | None | $1,258.93 | $1,778.28 | $2,041.74 |
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 $870.96 Median $1,174.90 Typical High $1,737.80 | Professional | None | $870.96 | $1,174.90 | $1,737.80 |
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 $660.69 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $660.69 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $263.03 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $933.25 | $933.25 | $933.25 |
Where Rhode Island sits
The same service costs 10.3 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 $16,837MD $1,634
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.