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 $12.02 Median $12.02 Typical High $12.02 | Facility | None | $12.02 | $12.02 | $12.02 |
Aetna Setting Professional Modifier None Typical Low $10.47 Median $12.02 Typical High $13.80 | Professional | None | $10.47 | $12.02 | $13.80 |
Ambetter Setting Professional Modifier None Typical Low $18.62 Median $18.62 Typical High $18.62 | Professional | None | $18.62 | $18.62 | $18.62 |
BCBS South Carolina Setting Professional Modifier None Typical Low $15.49 Median $15.85 Typical High $15.85 | Professional | None | $15.49 | $15.85 | $15.85 |
Cigna Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $6.31 | Professional | None | $6.31 | $6.31 | $6.31 |
Medcost Setting Facility Modifier None Typical Low $12.02 Median $12.02 Typical High $42.66 | Facility | None | $12.02 | $12.02 | $42.66 |
Medcost Setting Professional Modifier None Typical Low $14.13 Median $17.38 Typical High $52.48 | Professional | None | $14.13 | $17.38 | $52.48 |
United Setting Professional Modifier None Typical Low $5.37 Median $7.59 Typical High $9.33 | Professional | None | $5.37 | $7.59 | $9.33 |
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 $5.13 Median $6.03 Typical High $6.61 | Professional | 52 · Reduced service | $5.13 | $6.03 | $6.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.04 Median $2.45 Typical High $2.63 | Professional | 53 · Discontinued | $2.04 | $2.45 | $2.63 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $7.76 Median $9.12 Typical High $10.00 | Professional | 54 · Surgery only | $7.76 | $9.12 | $10.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.55 Median $1.82 Typical High $2.00 | Professional | 55 · Aftercare only | $1.55 | $1.82 | $2.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.02 Median $1.23 Typical High $1.32 | Professional | 56 · Pre-op care only | $1.02 | $1.23 | $1.32 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $7.08 Median $10.96 Typical High $26.30 | Professional | 51 · Multiple procedures | $7.08 | $10.96 | $26.30 |
Where South Carolina sits
The same service costs 4.5 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
$15.49
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.