How much rates vary
Facilitymedian $2,455 · 10th to 90th $871 to $5,888Professionalmedian $257 · 10th to 90th $186 to $347
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 $2,089.30 Median $2,754.23 Typical High $3,981.07 | Facility | None | $2,089.30 | $2,754.23 | $3,981.07 |
Aetna Setting Professional Modifier None Typical Low $245.47 Median $257.04 Typical High $338.84 | Professional | None | $245.47 | $257.04 | $338.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $190.55 Typical High $190.55 | Professional | 54 · Surgery only | $190.55 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | 55 · Aftercare only | $38.02 | $38.02 | $38.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | 56 · Pre-op care only | $25.70 | $25.70 | $25.70 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $169.82 Median $223.87 Typical High $380.19 | Professional | None | $169.82 | $223.87 | $380.19 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $154.88 Typical High $263.03 | Professional | 54 · Surgery only | $107.15 | $154.88 | $263.03 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $19.05 Typical High $32.36 | Professional | 55 · Aftercare only | $13.49 | $19.05 | $32.36 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $13.49 Median $19.05 Typical High $32.36 | Professional | 56 · Pre-op care only | $13.49 | $19.05 | $32.36 |
Cigna Setting Facility Modifier None Typical Low $588.84 Median $2,238.72 Typical High $3,235.94 | Facility | None | $588.84 | $2,238.72 | $3,235.94 |
Cigna Setting Professional Modifier None Typical Low $213.80 Median $316.23 Typical High $389.05 | Professional | None | $213.80 | $316.23 | $389.05 |
United Setting Facility Modifier None Typical Low $870.96 Median $2,089.30 Typical High $7,079.46 | Facility | None | $870.96 | $2,089.30 | $7,079.46 |
United Setting Professional Modifier None Typical Low $165.96 Median $239.88 Typical High $323.59 | Professional | None | $165.96 | $239.88 | $323.59 |
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 $128.82 Median $128.82 Typical High $128.82 | Professional | 52 · Reduced service | $128.82 | $128.82 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $51.29 Median $51.29 Typical High $51.29 | Professional | 53 · Discontinued | $51.29 | $51.29 | $51.29 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $177.83 | $177.83 | $177.83 |
Where Rhode Island sits
The same service costs 8.1 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 $4,634MT $570
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.