How much rates vary
Facilitymedian $1,202 · 10th to 90th $372 to $6,457Professionalmedian $2,239 · 10th to 90th $1,660 to $3,311
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 $2,187.76 Median $2,187.76 Typical High $2,187.76 | Professional | None | $2,187.76 | $2,187.76 | $2,187.76 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,659.59 Median $1,659.59 Typical High $1,659.59 | Professional | 54 · Surgery only | $1,659.59 | $1,659.59 | $1,659.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $331.13 Median $331.13 Typical High $331.13 | Professional | 55 · Aftercare only | $331.13 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $218.78 Median $218.78 Typical High $218.78 | Professional | 56 · Pre-op care only | $218.78 | $218.78 | $218.78 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $1,698.24 Median $2,238.72 Typical High $3,467.37 | Professional | None | $1,698.24 | $2,238.72 | $3,467.37 |
BCBS Rhode Island Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,445.44 Typical High $1,698.24 | Professional | 54 · Surgery only | $1,202.26 | $1,445.44 | $1,698.24 |
BCBS Rhode Island Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $245.47 Typical High $295.12 | Professional | 55 · Aftercare only | $204.17 | $245.47 | $295.12 |
BCBS Rhode Island Setting Professional Modifier 56 · Pre-op care only Typical Low $173.78 Median $208.93 Typical High $245.47 | Professional | 56 · Pre-op care only | $173.78 | $208.93 | $245.47 |
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 $2,630.27 Median $3,090.30 Typical High $3,715.35 | Professional | None | $2,630.27 | $3,090.30 | $3,715.35 |
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 $1,513.56 Median $1,949.84 Typical High $3,388.44 | Professional | None | $1,513.56 | $1,949.84 | $3,388.44 |
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 $1,096.48 Median $1,096.48 Typical High $1,096.48 | Professional | 52 · Reduced service | $1,096.48 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $436.52 Median $436.52 Typical High $436.52 | Professional | 53 · Discontinued | $436.52 | $436.52 | $436.52 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,548.82 Median $1,548.82 Typical High $1,548.82 | Professional | 78 · Unplanned return to OR | $1,548.82 | $1,548.82 | $1,548.82 |
Where Rhode Island sits
The same service costs 14.4 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 $34,547MD $2,395
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.