How much rates vary
Facilitymedian $7 · 10th to 90th $5 to $11Professionalmedian $7 · 10th to 90th $5 to $11
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 $4.90 Median $4.90 Typical High $4.90 | Facility | None | $4.90 | $4.90 | $4.90 |
Aetna Setting Professional Modifier None (both parts) Typical Low $4.90 Median $4.90 Typical High $6.92 | Professional | None (both parts) | $4.90 | $4.90 | $6.92 |
Ambetter Setting Professional Modifier None (both parts) Typical Low $11.75 Median $11.75 Typical High $11.75 | Professional | None (both parts) | $11.75 | $11.75 | $11.75 |
BCBS South Carolina Setting Facility Modifier None Typical Low $10.23 Median $11.22 Typical High $11.22 | Facility | None | $10.23 | $11.22 | $11.22 |
BCBS South Carolina Setting Professional Modifier None (both parts) Typical Low $6.92 Median $7.08 Typical High $11.22 | Professional | None (both parts) | $6.92 | $7.08 | $11.22 |
Cigna Setting Facility Modifier None Typical Low $7.08 Median $7.08 Typical High $7.08 | Facility | None | $7.08 | $7.08 | $7.08 |
Cigna Setting Professional Modifier None (both parts) Typical Low $5.25 Median $5.25 Typical High $7.08 | Professional | None (both parts) | $5.25 | $5.25 | $7.08 |
Medcost Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $6.61 | Professional | None | $6.31 | $6.31 | $6.61 |
Medcost Setting Facility Modifier None Typical Low $3.55 Median $5.37 Typical High $13.49 | Facility | None | $3.55 | $5.37 | $13.49 |
Medcost Setting Professional Modifier None (both parts) Typical Low $6.03 Median $7.94 Typical High $14.79 | Professional | None (both parts) | $6.03 | $7.94 | $14.79 |
Molina Setting Professional Modifier None (both parts) Typical Low $7.41 Median $7.41 Typical High $7.41 | Professional | None (both parts) | $7.41 | $7.41 | $7.41 |
United Setting Facility Modifier None Typical Low $6.31 Median $7.94 Typical High $15.14 | Facility | None | $6.31 | $7.94 | $15.14 |
United Setting Professional Modifier None (both parts) Typical Low $4.37 Median $5.50 Typical High $8.32 | Professional | None (both parts) | $4.37 | $5.50 | $8.32 |
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 $2.45 Median $2.45 Typical High $3.47 | Professional | 52 · Reduced service | $2.45 | $2.45 | $3.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.00 Median $1.00 Typical High $1.41 | Professional | 53 · Discontinued | $1.00 | $1.00 | $1.41 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.74 Median $0.74 Typical High $1.05 | Professional | 55 · Aftercare only | $0.74 | $0.74 | $1.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.49 Median $0.49 Typical High $0.71 | Professional | 56 · Pre-op care only | $0.49 | $0.49 | $0.71 |
Medcost Setting Professional Modifier 26 · Professional part Typical Low $3.24 Median $3.31 Typical High $7.76 | Professional | 26 · Professional part | $3.24 | $3.31 | $7.76 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $8.91 Median $12.02 Typical High $29.51 | Professional | 50 · Both sides | $8.91 | $12.02 | $29.51 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $3.02 Median $3.98 Typical High $9.77 | Professional | 51 · Multiple procedures | $3.02 | $3.98 | $9.77 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $1.20 Median $1.58 Typical High $3.89 | Professional | 80 · Assistant surgeon | $1.20 | $1.58 | $3.89 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $0.83 Median $1.12 Typical High $2.75 | Professional | 81 · Minimal assistant surgeon | $0.83 | $1.12 | $2.75 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $0.83 Median $1.12 Typical High $2.75 | Professional | 82 · Assistant surgeon, no resident | $0.83 | $1.12 | $2.75 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $0.83 Median $1.12 Typical High $2.75 | Professional | AS · PA/NP assist | $0.83 | $1.12 | $2.75 |
Medcost Setting Professional Modifier TC · Technical part Typical Low $4.79 Median $5.01 Typical High $11.75 | Professional | TC · Technical part | $4.79 | $5.01 | $11.75 |
Where South Carolina sits
The same service costs 3.5 times more in Montana than in Kansas. 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· 30th of 51
$7.08
MT $15.49KS $4.37
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.