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 $9.33 Median $9.33 Typical High $9.33 | Facility | None | $9.33 | $9.33 | $9.33 |
Aetna Setting Professional Modifier None Typical Low $7.41 Median $9.33 Typical High $10.23 | Professional | None | $7.41 | $9.33 | $10.23 |
BCBS South Carolina Setting Professional Modifier None Typical Low $12.02 Median $12.88 Typical High $12.88 | Professional | None | $12.02 | $12.88 | $12.88 |
Cigna Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $4.90 | Professional | None | $4.90 | $4.90 | $4.90 |
Medcost Setting Facility Modifier None Typical Low $9.12 Median $9.33 Typical High $33.11 | Facility | None | $9.12 | $9.33 | $33.11 |
Medcost Setting Professional Modifier None Typical Low $13.18 Median $15.14 Typical High $23.99 | Professional | None | $13.18 | $15.14 | $23.99 |
United Setting Professional Modifier None Typical Low $4.17 Median $5.75 Typical High $7.24 | Professional | None | $4.17 | $5.75 | $7.24 |
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 $3.98 Median $4.68 Typical High $5.13 | Professional | 52 · Reduced service | $3.98 | $4.68 | $5.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.58 Median $1.86 Typical High $2.04 | Professional | 53 · Discontinued | $1.58 | $1.86 | $2.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $5.89 Median $7.08 Typical High $7.59 | Professional | 54 · Surgery only | $5.89 | $7.08 | $7.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.17 Median $1.41 Typical High $1.51 | Professional | 55 · Aftercare only | $1.17 | $1.41 | $1.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.79 Median $0.93 Typical High $1.02 | Professional | 56 · Pre-op care only | $0.79 | $0.93 | $1.02 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $6.76 Median $7.76 Typical High $12.02 | Professional | 51 · Multiple procedures | $6.76 | $7.76 | $12.02 |
Where South Carolina sits
The same service costs 2.9 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
$12.02
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.