How much rates vary
Facilitymedian $1,096 · 10th to 90th $251 to $4,266Professionalmedian $1,778 · 10th to 90th $1,288 to $2,344
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 $1,778.28 Median $1,778.28 Typical High $1,778.28 | Professional | None | $1,778.28 | $1,778.28 | $1,778.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,318.26 Median $1,318.26 Typical High $1,318.26 | Professional | 54 · Surgery only | $1,318.26 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $263.03 Median $263.03 Typical High $263.03 | Professional | 55 · Aftercare only | $263.03 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | 56 · Pre-op care only | $177.83 | $177.83 | $177.83 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $1,174.90 Median $1,584.89 Typical High $2,630.27 | Professional | None | $1,174.90 | $1,584.89 | $2,630.27 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $1,096.48 Typical High $1,862.09 | Professional | 54 · Surgery only | $776.25 | $1,096.48 | $1,862.09 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $83.18 Median $120.23 Typical High $199.53 | Professional | 55 · Aftercare only | $83.18 | $120.23 | $199.53 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $74.13 Median $107.15 Typical High $177.83 | Professional | 56 · Pre-op care only | $74.13 | $107.15 | $177.83 |
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 $1,659.59 Median $2,344.23 Typical High $2,691.53 | Professional | None | $1,659.59 | $2,344.23 | $2,691.53 |
United Setting Facility Modifier None Typical Low $346.74 Median $870.96 Typical High $4,265.80 | Facility | None | $346.74 | $870.96 | $4,265.80 |
United Setting Professional Modifier None Typical Low $1,122.02 Median $1,621.81 Typical High $2,290.87 | Professional | None | $1,122.02 | $1,621.81 | $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 $870.96 Median $870.96 Typical High $870.96 | Professional | 52 · Reduced service | $870.96 | $870.96 | $870.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $354.81 Median $354.81 Typical High $354.81 | Professional | 53 · Discontinued | $354.81 | $354.81 | $354.81 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,230.27 Median $1,230.27 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $1,230.27 | $1,230.27 | $1,230.27 |
Where Rhode Island sits
The same service costs 13.1 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 $24,687MD $1,882
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.