How much rates vary
Facilitymedian $1,549 · 10th to 90th $646 to $4,898Professionalmedian $234 · 10th to 90th $141 to $372
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 $1,513.56 Median $1,548.82 Typical High $3,981.07 | Facility | None | $1,513.56 | $1,548.82 | $3,981.07 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $213.80 Typical High $245.47 | Professional | None | $173.78 | $213.80 | $245.47 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $141.25 Typical High $181.97 | Professional | 54 · Surgery only | $128.82 | $141.25 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $28.18 Typical High $36.31 | Professional | 55 · Aftercare only | $25.70 | $28.18 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $18.62 Typical High $24.55 | Professional | 56 · Pre-op care only | $17.38 | $18.62 | $24.55 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $141.25 Median $208.93 Typical High $309.03 | Professional | None | $141.25 | $208.93 | $309.03 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $138.04 Typical High $213.80 | Professional | 54 · Surgery only | $93.33 | $138.04 | $213.80 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $17.38 Typical High $26.92 | Professional | 55 · Aftercare only | $11.48 | $17.38 | $26.92 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $17.38 Typical High $26.92 | Professional | 56 · Pre-op care only | $11.48 | $17.38 | $26.92 |
Cigna Setting Facility Modifier None Typical Low $446.68 Median $1,479.11 Typical High $2,089.30 | Facility | None | $446.68 | $1,479.11 | $2,089.30 |
Cigna Setting Professional Modifier None Typical Low $190.55 Median $275.42 Typical High $371.54 | Professional | None | $190.55 | $275.42 | $371.54 |
United Setting Facility Modifier None Typical Low $645.65 Median $1,445.44 Typical High $5,011.87 | Facility | None | $645.65 | $1,445.44 | $5,011.87 |
United Setting Professional Modifier None Typical Low $138.04 Median $208.93 Typical High $309.03 | Professional | None | $138.04 | $208.93 | $309.03 |
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 $85.11 Median $93.33 Typical High $123.03 | Professional | 52 · Reduced service | $85.11 | $93.33 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $37.15 Typical High $48.98 | Professional | 53 · Discontinued | $34.67 | $37.15 | $48.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $131.83 Typical High $169.82 | Professional | 78 · Unplanned return to OR | $120.23 | $131.83 | $169.82 |
Where Rhode Island sits
The same service costs 9.9 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 $4,605MT $466
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.