How much rates vary
Facilitymedian $115 · 10th to 90th $74 to $162Professionalmedian $95 · 10th to 90th $72 to $132
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 $85.11 Median $85.11 Typical High $114.82 | Facility | None | $85.11 | $85.11 | $114.82 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $109.65 Typical High $125.89 | Professional | None | $85.11 | $109.65 | $125.89 |
Ambetter Setting Professional Modifier None Typical Low $69.18 Median $109.65 Typical High $190.55 | Professional | None | $69.18 | $109.65 | $190.55 |
BCBS South Carolina Setting Facility Modifier None Typical Low $54.95 Median $147.91 Typical High $169.82 | Facility | None | $54.95 | $147.91 | $169.82 |
BCBS South Carolina Setting Professional Modifier None Typical Low $77.62 Median $97.72 Typical High $104.71 | Professional | None | $77.62 | $97.72 | $104.71 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $89.13 Typical High $138.04 | Professional | None | $75.86 | $89.13 | $138.04 |
Medcost Setting Professional Modifier None Typical Low $91.20 Median $114.82 Typical High $218.78 | Professional | None | $91.20 | $114.82 | $218.78 |
Medcost Setting Facility Modifier None Typical Low $85.11 Median $104.71 Typical High $138.04 | Facility | None | $85.11 | $104.71 | $138.04 |
Medcost Setting Professional Modifier None Typical Low $72.44 Median $100.00 Typical High $131.83 | Professional | None | $72.44 | $100.00 | $131.83 |
Molina Setting Professional Modifier None Typical Low $56.23 Median $93.33 Typical High $131.83 | Professional | None | $56.23 | $93.33 | $131.83 |
United Setting Professional Modifier None Typical Low $64.57 Median $87.10 Typical High $125.89 | Professional | None | $64.57 | $87.10 | $125.89 |
10 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 $42.66 Median $44.67 Typical High $57.54 | Professional | 52 · Reduced service | $42.66 | $44.67 | $57.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $13.18 Typical High $16.98 | Professional | 55 · Aftercare only | $12.88 | $13.18 | $16.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $8.91 Typical High $11.48 | Professional | 56 · Pre-op care only | $8.51 | $8.91 | $11.48 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $100.00 Median $114.82 Typical High $181.97 | Professional | 25 · Same-day visit | $100.00 | $114.82 | $181.97 |
Ambetter Setting Professional Modifier AF · Specialist physician Typical Low $117.49 Median $117.49 Typical High $117.49 | Professional | AF · Specialist physician | $117.49 | $117.49 | $117.49 |
Ambetter Setting Professional Modifier CG · Policy criteria applied Typical Low $104.71 Median $104.71 Typical High $104.71 | Professional | CG · Policy criteria applied | $104.71 | $104.71 | $104.71 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | GC · Resident with teaching physician | $162.18 | $162.18 | $162.18 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | GE · Resident, primary care exception | $204.17 | $204.17 | $204.17 |
BCBS South Carolina Setting Professional Modifier 29 Typical Low $54.95 Median $54.95 Typical High $63.10 | Professional | 29 | $54.95 | $54.95 | $63.10 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $35.48 Median $50.12 Typical High $83.18 | Professional | 51 · Multiple procedures | $35.48 | $50.12 | $83.18 |
Where South Carolina sits
The same service costs 2.7 times more in Alaska than in Washington, DC. 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.
South Carolina· 42nd of 51
$95.50
AK $224DC $83.18
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.