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 $537,031.80 Median $537,031.80 Typical High $537,031.80 | Facility | None | $537,031.80 | $537,031.80 | $537,031.80 |
Aetna Setting Professional Modifier None Typical Low $512,861.38 Median $537,031.80 Typical High $537,031.80 | Professional | None | $512,861.38 | $537,031.80 | $537,031.80 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $257,039.58 Median $269,153.48 Typical High $269,153.48 | Professional | 52 · Reduced service | $257,039.58 | $269,153.48 | $269,153.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $102,329.30 Median $107,151.93 Typical High $107,151.93 | Professional | 53 · Discontinued | $102,329.30 | $107,151.93 | $107,151.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $75,857.76 Median $79,432.82 Typical High $79,432.82 | Professional | 55 · Aftercare only | $75,857.76 | $79,432.82 | $79,432.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $51,286.14 Median $53,703.18 Typical High $53,703.18 | Professional | 56 · Pre-op care only | $51,286.14 | $53,703.18 | $53,703.18 |
BCBS South Carolina Setting Professional Modifier None Typical Low $512,861.38 Median $512,861.38 Typical High $524,807.46 | Professional | None | $512,861.38 | $512,861.38 | $524,807.46 |
Medcost Setting Facility Modifier None Typical Low $537,031.80 Median $645,654.23 Typical High $1,318,256.74 | Facility | None | $537,031.80 | $645,654.23 | $1,318,256.74 |
Medcost Setting Professional Modifier None Typical Low $354,813.39 Median $354,813.39 Typical High $602,559.59 | Professional | None | $354,813.39 | $354,813.39 | $602,559.59 |
Molina Setting Professional Modifier None Typical Low $30.20 Median $1,230,268.77 Typical High $1,288,249.55 | Professional | None | $30.20 | $1,230,268.77 | $1,288,249.55 |
United Setting Facility Modifier None Typical Low $512,861.38 Median $512,861.38 Typical High $1,096,478.20 | Facility | None | $512,861.38 | $512,861.38 | $1,096,478.20 |
United Setting Professional Modifier None Typical Low $489,778.82 Median $489,778.82 Typical High $645,654.23 | Professional | None | $489,778.82 | $489,778.82 | $645,654.23 |
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 $177,827.94 Median $177,827.94 Typical High $177,827.94 | Professional | 51 · Multiple procedures | $177,827.94 | $177,827.94 | $177,827.94 |
Where South Carolina sits
The same service costs 2.0 times more in Texas than in New Jersey. 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· 27th of 51
$512,861
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.