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 $5.75 Median $5.75 Typical High $5.75 | Facility | None | $5.75 | $5.75 | $5.75 |
Aetna Setting Professional Modifier None Typical Low $4.90 Median $5.75 Typical High $6.31 | Professional | None | $4.90 | $5.75 | $6.31 |
BCBS South Carolina Setting Professional Modifier None Typical Low $7.41 Median $7.94 Typical High $7.94 | Professional | None | $7.41 | $7.94 | $7.94 |
Cigna Setting Professional Modifier None Typical Low $3.02 Median $3.02 Typical High $3.02 | Professional | None | $3.02 | $3.02 | $3.02 |
Medcost Setting Facility Modifier None Typical Low $5.62 Median $5.75 Typical High $20.42 | Facility | None | $5.62 | $5.75 | $20.42 |
Medcost Setting Professional Modifier None Typical Low $6.17 Median $7.41 Typical High $11.22 | Professional | None | $6.17 | $7.41 | $11.22 |
United Setting Professional Modifier None Typical Low $2.51 Median $3.55 Typical High $4.47 | Professional | None | $2.51 | $3.55 | $4.47 |
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 $2.45 Median $2.88 Typical High $3.16 | Professional | 52 · Reduced service | $2.45 | $2.88 | $3.16 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.98 Median $1.15 Typical High $1.26 | Professional | 53 · Discontinued | $0.98 | $1.15 | $1.26 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.63 Median $4.37 Typical High $4.79 | Professional | 54 · Surgery only | $3.63 | $4.37 | $4.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.72 Median $0.87 Typical High $0.95 | Professional | 55 · Aftercare only | $0.72 | $0.87 | $0.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.49 Median $0.58 Typical High $0.63 | Professional | 56 · Pre-op care only | $0.49 | $0.58 | $0.63 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $3.09 Median $3.72 Typical High $6.17 | Professional | 51 · Multiple procedures | $3.09 | $3.72 | $6.17 |
Where South Carolina sits
The same service costs 2.7 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
$7.41
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.