How much rates vary
Facilitymedian $2,138 · 10th to 90th $661 to $17,378Professionalmedian $1,000 · 10th to 90th $158 to $1,514
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 $1,071.52 Median $12,022.64 Typical High $21,877.62 | Facility | None | $1,071.52 | $12,022.64 | $21,877.62 |
Aetna Setting Professional Modifier None Typical Low $954.99 Median $1,071.52 Typical High $1,318.26 | Professional | None | $954.99 | $1,071.52 | $1,318.26 |
Ambetter Setting Professional Modifier None Typical Low $1,513.56 Median $1,513.56 Typical High $1,513.56 | Professional | None | $1,513.56 | $1,513.56 | $1,513.56 |
BCBS South Carolina Setting Facility Modifier None Typical Low $8,912.51 Median $10,000.00 Typical High $10,964.78 | Facility | None | $8,912.51 | $10,000.00 | $10,964.78 |
BCBS South Carolina Setting Professional Modifier None Typical Low $831.76 Median $1,000.00 Typical High $1,659.59 | Professional | None | $831.76 | $1,000.00 | $1,659.59 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $794.33 Typical High $1,905.46 | Facility | None | $100.00 | $794.33 | $1,905.46 |
Cigna Setting Professional Modifier None Typical Low $1,023.29 Median $1,071.52 Typical High $1,905.46 | Professional | None | $1,023.29 | $1,071.52 | $1,905.46 |
Medcost Setting Facility Modifier None Typical Low $851.14 Median $1,071.52 Typical High $1,445.44 | Facility | None | $851.14 | $1,071.52 | $1,445.44 |
Medcost Setting Professional Modifier None Typical Low $1,096.48 Median $1,230.27 Typical High $1,445.44 | Professional | None | $1,096.48 | $1,230.27 | $1,445.44 |
Molina Setting Professional Modifier None Typical Low $123.03 Median $912.01 Typical High $1,479.11 | Professional | None | $123.03 | $912.01 | $1,479.11 |
United Setting Facility Modifier None Typical Low $1,023.29 Median $3,311.31 Typical High $18,197.01 | Facility | None | $1,023.29 | $3,311.31 | $18,197.01 |
United Setting Professional Modifier None Typical Low $912.01 Median $1,122.02 Typical High $1,949.84 | Professional | None | $912.01 | $1,122.02 | $1,949.84 |
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 $478.63 Median $524.81 Typical High $524.81 | Professional | 52 · Reduced service | $478.63 | $524.81 | $524.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $190.55 Median $213.80 Typical High $213.80 | Professional | 53 · Discontinued | $190.55 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $707.95 Median $794.33 Typical High $794.33 | Professional | 54 · Surgery only | $707.95 | $794.33 | $794.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $141.25 Median $158.49 Typical High $158.49 | Professional | 55 · Aftercare only | $141.25 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $95.50 Median $107.15 Typical High $107.15 | Professional | 56 · Pre-op care only | $95.50 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $741.31 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $660.69 | $741.31 | $741.31 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $588.84 Median $630.96 Typical High $870.96 | Professional | 51 · Multiple procedures | $588.84 | $630.96 | $870.96 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $234.42 Median $251.19 Typical High $346.74 | Professional | 80 · Assistant surgeon | $234.42 | $251.19 | $346.74 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $162.18 Median $177.83 Typical High $245.47 | Professional | 81 · Minimal assistant surgeon | $162.18 | $177.83 | $245.47 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $162.18 Median $177.83 Typical High $245.47 | Professional | 82 · Assistant surgeon, no resident | $162.18 | $177.83 | $245.47 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $162.18 Median $177.83 Typical High $245.47 | Professional | AS · PA/NP assist | $162.18 | $177.83 | $245.47 |
Where South Carolina sits
The same service costs 9.9 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 $23,705TX $2,398
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.