How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $0.35 Median $0.35 Typical High $0.35 | Facility | None | $0.35 | $0.35 | $0.35 |
Aetna Setting Professional Modifier None Typical Low $0.28 Median $0.35 Typical High $0.39 | Professional | None | $0.28 | $0.35 | $0.39 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.16 Median $0.18 Typical High $0.20 | Professional | 52 · Reduced service | $0.16 | $0.18 | $0.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.06 Median $0.07 Typical High $0.08 | Professional | 53 · Discontinued | $0.06 | $0.07 | $0.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.06 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.06 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.04 Typical High $0.04 | Professional | 56 · Pre-op care only | $0.03 | $0.04 | $0.04 |
BCBS South Carolina Setting Professional Modifier None Typical Low $0.45 Median $0.46 Typical High $0.46 | Professional | None | $0.45 | $0.46 | $0.46 |
Cigna Setting Professional Modifier None Typical Low $0.22 Median $0.22 Typical High $0.22 | Professional | None | $0.22 | $0.22 | $0.22 |
Medcost Setting Facility Modifier None Typical Low $0.32 Median $0.35 Typical High $1.23 | Facility | None | $0.32 | $0.35 | $1.23 |
Medcost Setting Professional Modifier None Typical Low $0.34 Median $0.50 Typical High $1.00 | Professional | None | $0.34 | $0.50 | $1.00 |
United Setting Professional Modifier None Typical Low $0.16 Median $0.22 Typical High $0.28 | Professional | None | $0.16 | $0.22 | $0.28 |
1 more rate 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 |
|---|---|---|---|---|---|
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $0.17 Median $0.32 Typical High $0.50 | Professional | 51 · Multiple procedures | $0.17 | $0.32 | $0.50 |
Where South Carolina sits
The same service costs 2.5 times more in Hawaii than in Utah. 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· 4th of 51
$0.45
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.