How much rates vary
Facilitymedian $759 · 10th to 90th $145 to $1,585Professionalmedian $151 · 10th to 90th $95 to $214
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 $128.82 Median $5,623.41 Typical High $21,877.62 | Facility | None | $128.82 | $5,623.41 | $21,877.62 |
Aetna Setting Professional Modifier None Typical Low $123.03 Median $154.88 Typical High $190.55 | Professional | None | $123.03 | $154.88 | $190.55 |
Ambetter Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | None | $151.36 | $151.36 | $151.36 |
BCBS South Carolina Setting Facility Modifier None Typical Low $537.03 Median $870.96 Typical High $1,380.38 | Facility | None | $537.03 | $870.96 | $1,380.38 |
BCBS South Carolina Setting Professional Modifier None Typical Low $93.33 Median $125.89 Typical High $154.88 | Professional | None | $93.33 | $125.89 | $154.88 |
Cigna Setting Facility Modifier None Typical Low $144.54 Median $389.05 Typical High $977.24 | Facility | None | $144.54 | $389.05 | $977.24 |
Cigna Setting Professional Modifier None Typical Low $107.15 Median $162.18 Typical High $234.42 | Professional | None | $107.15 | $162.18 | $234.42 |
Medcost Setting Professional Modifier None Typical Low $213.80 Median $229.09 Typical High $389.05 | Professional | None | $213.80 | $229.09 | $389.05 |
Medcost Setting Facility Modifier None Typical Low $128.82 Median $234.42 Typical High $851.14 | Facility | None | $128.82 | $234.42 | $851.14 |
Medcost Setting Professional Modifier None Typical Low $151.36 Median $181.97 Typical High $204.17 | Professional | None | $151.36 | $181.97 | $204.17 |
Molina Setting Professional Modifier None Typical Low $123.03 Median $158.49 Typical High $245.47 | Professional | None | $123.03 | $158.49 | $245.47 |
United Setting Facility Modifier None Typical Low $83.18 Median $446.68 Typical High $2,238.72 | Facility | None | $83.18 | $446.68 | $2,238.72 |
United Setting Professional Modifier None Typical Low $93.33 Median $144.54 Typical High $239.88 | Professional | None | $93.33 | $144.54 | $239.88 |
11 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 $60.26 Median $74.13 Typical High $95.50 | Professional | 52 · Reduced service | $60.26 | $74.13 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $29.51 Typical High $38.02 | Professional | 53 · Discontinued | $24.55 | $29.51 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $112.20 Typical High $141.25 | Professional | 54 · Surgery only | $91.20 | $112.20 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $22.39 Typical High $28.18 | Professional | 55 · Aftercare only | $18.20 | $22.39 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $14.79 Typical High $19.05 | Professional | 56 · Pre-op care only | $12.30 | $14.79 | $19.05 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $104.71 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $85.11 | $104.71 | $131.83 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $74.13 Median $100.00 Typical High $114.82 | Professional | 51 · Multiple procedures | $74.13 | $100.00 | $114.82 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $30.20 Median $40.74 Typical High $45.71 | Professional | 80 · Assistant surgeon | $30.20 | $40.74 | $45.71 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $20.89 Median $28.18 Typical High $32.36 | Professional | 81 · Minimal assistant surgeon | $20.89 | $28.18 | $32.36 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $20.89 Median $28.18 Typical High $32.36 | Professional | 82 · Assistant surgeon, no resident | $20.89 | $28.18 | $32.36 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $20.89 Median $28.18 Typical High $32.36 | Professional | AS · PA/NP assist | $20.89 | $28.18 | $32.36 |
Where South Carolina sits
The same service costs 9.1 times more in New York than in Delaware. 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
NY $2,759DE $302
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.