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 $38.02 Median $38.02 Typical High $38.02 | Facility | None | $38.02 | $38.02 | $38.02 |
Aetna Setting Professional Modifier None Typical Low $29.51 Median $38.02 Typical High $41.69 | Professional | None | $29.51 | $38.02 | $41.69 |
Ambetter Setting Professional Modifier None Typical Low $57.54 Median $57.54 Typical High $57.54 | Professional | None | $57.54 | $57.54 | $57.54 |
BCBS South Carolina Setting Professional Modifier None Typical Low $48.98 Median $48.98 Typical High $48.98 | Professional | None | $48.98 | $48.98 | $48.98 |
Cigna Setting Professional Modifier None Typical Low $19.95 Median $19.95 Typical High $19.95 | Professional | None | $19.95 | $19.95 | $19.95 |
Medcost Setting Facility Modifier None Typical Low $37.15 Median $38.02 Typical High $134.90 | Facility | None | $37.15 | $38.02 | $134.90 |
Medcost Setting Professional Modifier None Typical Low $31.62 Median $35.48 Typical High $63.10 | Professional | None | $31.62 | $35.48 | $63.10 |
United Setting Professional Modifier None Typical Low $16.98 Median $23.44 Typical High $29.51 | Professional | None | $16.98 | $23.44 | $29.51 |
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 $15.85 Median $19.05 Typical High $20.89 | Professional | 52 · Reduced service | $15.85 | $19.05 | $20.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.31 Median $7.59 Typical High $8.32 | Professional | 53 · Discontinued | $6.31 | $7.59 | $8.32 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $23.99 Median $28.18 Typical High $30.90 | Professional | 54 · Surgery only | $23.99 | $28.18 | $30.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.79 Median $5.75 Typical High $6.31 | Professional | 55 · Aftercare only | $4.79 | $5.75 | $6.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.16 Median $3.80 Typical High $4.17 | Professional | 56 · Pre-op care only | $3.16 | $3.80 | $4.17 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $15.85 Median $17.78 Typical High $40.74 | Professional | 51 · Multiple procedures | $15.85 | $17.78 | $40.74 |
Where South Carolina sits
The same service costs 2.8 times more in Hawaii 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· 4th of 51
$48.98
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.