How much rates vary
Facilitymedian $4,365 · 10th to 90th $1,479 to $19,498Professionalmedian $603 · 10th to 90th $107 to $912
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 $660.69 Median $12,022.64 Typical High $22,908.68 | Facility | None | $660.69 | $12,022.64 | $22,908.68 |
Aetna Setting Professional Modifier None Typical Low $562.34 Median $660.69 Typical High $812.83 | Professional | None | $562.34 | $660.69 | $812.83 |
Ambetter Setting Professional Modifier None Typical Low $100.00 Median $100.00 Typical High $933.25 | Professional | None | $100.00 | $100.00 | $933.25 |
BCBS South Carolina Setting Facility Modifier None Typical Low $1,737.80 Median $6,606.93 Typical High $19,054.61 | Facility | None | $1,737.80 | $6,606.93 | $19,054.61 |
BCBS South Carolina Setting Professional Modifier None Typical Low $524.81 Median $707.95 Typical High $851.14 | Professional | None | $524.81 | $707.95 | $851.14 |
Cigna Setting Facility Modifier None Typical Low $630.96 Median $3,311.31 Typical High $4,897.79 | Facility | None | $630.96 | $3,311.31 | $4,897.79 |
Cigna Setting Professional Modifier None Typical Low $537.03 Median $575.44 Typical High $912.01 | Professional | None | $537.03 | $575.44 | $912.01 |
Medcost Setting Professional Modifier None Typical Low $691.83 Median $741.31 Typical High $1,318.26 | Professional | None | $691.83 | $741.31 | $1,318.26 |
Medcost Setting Facility Modifier None Typical Low $616.60 Median $1,445.44 Typical High $3,311.31 | Facility | None | $616.60 | $1,445.44 | $3,311.31 |
Medcost Setting Professional Modifier None Typical Low $645.65 Median $660.69 Typical High $954.99 | Professional | None | $645.65 | $660.69 | $954.99 |
Molina Setting Professional Modifier None Typical Low $75.86 Median $549.54 Typical High $891.25 | Professional | None | $75.86 | $549.54 | $891.25 |
United Setting Facility Modifier None Typical Low $1,819.70 Median $6,165.95 Typical High $23,988.33 | Facility | None | $1,819.70 | $6,165.95 | $23,988.33 |
United Setting Professional Modifier None Typical Low $457.09 Median $562.34 Typical High $933.25 | Professional | None | $457.09 | $562.34 | $933.25 |
12 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 $275.42 Median $331.13 Typical High $331.13 | Professional | 52 · Reduced service | $275.42 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $112.20 Median $134.90 Typical High $134.90 | Professional | 53 · Discontinued | $112.20 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $416.87 Median $501.19 Typical High $501.19 | Professional | 54 · Surgery only | $416.87 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $83.18 Median $100.00 Typical High $100.00 | Professional | 55 · Aftercare only | $83.18 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $56.23 Median $66.07 Typical High $66.07 | Professional | 56 · Pre-op care only | $56.23 | $66.07 | $66.07 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $389.05 Median $467.74 Typical High $467.74 | Professional | 78 · Unplanned return to OR | $389.05 | $467.74 | $467.74 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $977.24 Median $1,096.48 Typical High $1,445.44 | Professional | 50 · Both sides | $977.24 | $1,096.48 | $1,445.44 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $323.59 Median $371.54 Typical High $478.63 | Professional | 51 · Multiple procedures | $323.59 | $371.54 | $478.63 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $131.83 Median $147.91 Typical High $190.55 | Professional | 80 · Assistant surgeon | $131.83 | $147.91 | $190.55 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $91.20 Median $102.33 Typical High $134.90 | Professional | 81 · Minimal assistant surgeon | $91.20 | $102.33 | $134.90 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $91.20 Median $102.33 Typical High $134.90 | Professional | 82 · Assistant surgeon, no resident | $91.20 | $102.33 | $134.90 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $91.20 Median $102.33 Typical High $134.90 | Professional | AS · PA/NP assist | $91.20 | $102.33 | $134.90 |
Where South Carolina sits
The same service costs 6.0 times more in Wisconsin 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
WI $11,096MT $1,846
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.