How much rates vary
Facilitymedian $1,202 · 10th to 90th $372 to $6,457Professionalmedian $2,818 · 10th to 90th $2,042 to $4,074
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 $2,691.53 Median $2,691.53 Typical High $2,691.53 | Professional | None | $2,691.53 | $2,691.53 | $2,691.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,041.74 Median $2,041.74 Typical High $2,041.74 | Professional | 54 · Surgery only | $2,041.74 | $2,041.74 | $2,041.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $407.38 Median $407.38 Typical High $407.38 | Professional | 55 · Aftercare only | $407.38 | $407.38 | $407.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $269.15 Median $269.15 Typical High $269.15 | Professional | 56 · Pre-op care only | $269.15 | $269.15 | $269.15 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $2,137.96 Median $2,818.38 Typical High $4,265.80 | Professional | None | $2,137.96 | $2,818.38 | $4,265.80 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $1,513.56 Median $1,819.70 Typical High $2,137.96 | Professional | 54 · Surgery only | $1,513.56 | $1,819.70 | $2,137.96 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $316.23 Typical High $371.54 | Professional | 55 · Aftercare only | $257.04 | $316.23 | $371.54 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $218.78 Median $263.03 Typical High $309.03 | Professional | 56 · Pre-op care only | $218.78 | $263.03 | $309.03 |
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 $3,311.31 Median $3,890.45 Typical High $4,677.35 | Professional | None | $3,311.31 | $3,890.45 | $4,677.35 |
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 $1,862.09 Median $2,454.71 Typical High $4,265.80 | Professional | None | $1,862.09 | $2,454.71 | $4,265.80 |
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 $1,348.96 Median $1,348.96 Typical High $1,348.96 | Professional | 52 · Reduced service | $1,348.96 | $1,348.96 | $1,348.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $537.03 Median $537.03 Typical High $537.03 | Professional | 53 · Discontinued | $537.03 | $537.03 | $537.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,905.46 Median $1,905.46 Typical High $1,905.46 | Professional | 78 · Unplanned return to OR | $1,905.46 | $1,905.46 | $1,905.46 |
Where Rhode Island sits
The same service costs 13.8 times more in Maine than in Texas. 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 $35,114TX $2,545
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.