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 $40.74 Median $40.74 Typical High $40.74 | Facility | None | $40.74 | $40.74 | $40.74 |
Aetna Setting Professional Modifier None Typical Low $34.67 Median $40.74 Typical High $44.67 | Professional | None | $34.67 | $40.74 | $44.67 |
Ambetter Setting Professional Modifier None Typical Low $52.48 Median $64.57 Typical High $75.86 | Professional | None | $52.48 | $64.57 | $75.86 |
BCBS South Carolina Setting Professional Modifier None Typical Low $52.48 Median $52.48 Typical High $52.48 | Professional | None | $52.48 | $52.48 | $52.48 |
Cigna Setting Professional Modifier None Typical Low $21.38 Median $21.38 Typical High $21.38 | Professional | None | $21.38 | $21.38 | $21.38 |
Medcost Setting Facility Modifier None Typical Low $39.81 Median $40.74 Typical High $144.54 | Facility | None | $39.81 | $40.74 | $144.54 |
Medcost Setting Professional Modifier None Typical Low $34.67 Median $58.88 Typical High $131.83 | Professional | None | $34.67 | $58.88 | $131.83 |
United Setting Professional Modifier None Typical Low $18.20 Median $25.70 Typical High $31.62 | Professional | None | $18.20 | $25.70 | $31.62 |
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 $17.38 Median $20.42 Typical High $22.39 | Professional | 52 · Reduced service | $17.38 | $20.42 | $22.39 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.92 Median $8.32 Typical High $8.91 | Professional | 53 · Discontinued | $6.92 | $8.32 | $8.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $26.30 Median $30.90 Typical High $33.88 | Professional | 54 · Surgery only | $26.30 | $30.90 | $33.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.25 Median $6.17 Typical High $6.76 | Professional | 55 · Aftercare only | $5.25 | $6.17 | $6.76 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.47 Median $4.07 Typical High $4.47 | Professional | 56 · Pre-op care only | $3.47 | $4.07 | $4.47 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $17.38 Median $36.31 Typical High $66.07 | Professional | 51 · Multiple procedures | $17.38 | $36.31 | $66.07 |
Where South Carolina sits
The same service costs 2.6 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
$52.48
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.