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 $28.84 Median $28.84 Typical High $28.84 | Facility | None | $28.84 | $28.84 | $28.84 |
Aetna Setting Professional Modifier None Typical Low $25.12 Median $28.84 Typical High $31.62 | Professional | None | $25.12 | $28.84 | $31.62 |
Ambetter Setting Professional Modifier None Typical Low $21.38 Median $21.38 Typical High $21.38 | Professional | None | $21.38 | $21.38 | $21.38 |
BCBS South Carolina Setting Professional Modifier None Typical Low $37.15 Median $38.02 Typical High $38.02 | Professional | None | $37.15 | $38.02 | $38.02 |
Cigna Setting Professional Modifier None Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | None | $15.14 | $15.14 | $15.14 |
Medcost Setting Facility Modifier None Typical Low $28.84 Median $28.84 Typical High $102.33 | Facility | None | $28.84 | $28.84 | $102.33 |
Medcost Setting Professional Modifier None Typical Low $32.36 Median $41.69 Typical High $83.18 | Professional | None | $32.36 | $41.69 | $83.18 |
United Setting Professional Modifier None Typical Low $12.88 Median $18.20 Typical High $22.39 | Professional | None | $12.88 | $18.20 | $22.39 |
6 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 $12.30 Median $14.45 Typical High $15.85 | Professional | 52 · Reduced service | $12.30 | $14.45 | $15.85 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.90 Median $5.89 Typical High $6.46 | Professional | 53 · Discontinued | $4.90 | $5.89 | $6.46 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $18.62 Median $21.88 Typical High $23.99 | Professional | 54 · Surgery only | $18.62 | $21.88 | $23.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.72 Median $4.37 Typical High $4.79 | Professional | 55 · Aftercare only | $3.72 | $4.37 | $4.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.45 Median $2.95 Typical High $3.16 | Professional | 56 · Pre-op care only | $2.45 | $2.95 | $3.16 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $15.85 Median $22.91 Typical High $41.69 | Professional | 51 · Multiple procedures | $15.85 | $22.91 | $41.69 |
Where South Carolina sits
The same service costs 3.1 times more in Rhode Island than in New York. 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· 5th of 51
$37.15
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.