How much rates vary
Facilitymedian $501 · 10th to 90th $282 to $2,089Professionalmedian $372 · 10th to 90th $263 to $589
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $263.03 Median $263.03 Typical High $275.42 | Facility | None | $263.03 | $263.03 | $275.42 |
Aetna Setting Professional Modifier None Typical Low $263.03 Median $275.42 Typical High $288.40 | Professional | None | $263.03 | $275.42 | $288.40 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $131.83 Median $138.04 Typical High $144.54 | Professional | 52 · Reduced service | $131.83 | $138.04 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $52.48 Median $54.95 Typical High $57.54 | Professional | 53 · Discontinued | $52.48 | $54.95 | $57.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.90 Median $41.69 Typical High $42.66 | Professional | 55 · Aftercare only | $38.90 | $41.69 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.30 Median $27.54 Typical High $28.84 | Professional | 56 · Pre-op care only | $26.30 | $27.54 | $28.84 |
Capital Blue Cross Setting Facility Modifier None Typical Low $4,265.80 Median $5,011.87 Typical High $79,432.82 | Facility | None | $4,265.80 | $5,011.87 | $79,432.82 |
Capital Blue Cross Setting Professional Modifier None Typical Low $478.63 Median $588.84 Typical High $588.84 | Professional | None | $478.63 | $588.84 | $588.84 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $501.19 Typical High $501.19 | Facility | None | $501.19 | $501.19 | $501.19 |
Cigna Setting Professional Modifier None Typical Low $371.54 Median $371.54 Typical High $3,235.94 | Professional | None | $371.54 | $371.54 | $3,235.94 |
Emblem Health Setting Professional Modifier None Typical Low $660.69 Median $1,047.13 Typical High $1,202.26 | Professional | None | $660.69 | $1,047.13 | $1,202.26 |
Geisinger Setting Facility Modifier None Typical Low $602.56 Median $602.56 Typical High $602.56 | Facility | None | $602.56 | $602.56 | $602.56 |
Geisinger Setting Professional Modifier None Typical Low $309.03 Median $354.81 Typical High $602.56 | Professional | None | $309.03 | $354.81 | $602.56 |
Martin's Point Setting Facility Modifier None Typical Low $263.03 Median $263.03 Typical High $263.03 | Facility | None | $263.03 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier None Typical Low $263.03 Median $275.42 Typical High $288.40 | Professional | None | $263.03 | $275.42 | $288.40 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $131.83 Median $138.04 Typical High $144.54 | Professional | 52 · Reduced service | $131.83 | $138.04 | $144.54 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $52.48 Median $54.95 Typical High $57.54 | Professional | 53 · Discontinued | $52.48 | $54.95 | $57.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $38.90 Median $41.69 Typical High $42.66 | Professional | 55 · Aftercare only | $38.90 | $41.69 | $42.66 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $26.30 Median $27.54 Typical High $28.84 | Professional | 56 · Pre-op care only | $26.30 | $27.54 | $28.84 |
Oscar Health Setting Professional Modifier None Typical Low $436.52 Median $1,000.00 Typical High $1,071.52 | Professional | None | $436.52 | $1,000.00 | $1,071.52 |
UPMC Health Plan Setting Facility Modifier None Typical Low $281.84 Median $1,258.93 Typical High $2,187.76 | Facility | None | $281.84 | $1,258.93 | $2,187.76 |
UPMC Health Plan Setting Professional Modifier None Typical Low $281.84 Median $281.84 Typical High $562.34 | Professional | None | $281.84 | $281.84 | $562.34 |
United Setting Facility Modifier None Typical Low $389.05 Median $389.05 Typical High $954.99 | Facility | None | $389.05 | $389.05 | $954.99 |
United Setting Professional Modifier None Typical Low $263.03 Median $295.12 Typical High $489.78 | Professional | None | $263.03 | $295.12 | $489.78 |
2 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 |
|---|---|---|---|---|---|
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $524.81 Median $588.84 Typical High $588.84 | Professional | 50 · Both sides | $524.81 | $588.84 | $588.84 |
Highmark BCBS Setting Professional Modifier K3 · Prosthesis level 3 Typical Low $436.52 Median $436.52 Typical High $436.52 | Professional | K3 · Prosthesis level 3 | $436.52 | $436.52 | $436.52 |
Where Pennsylvania sits
The same service costs 3.0 times more in Hawaii than in Washington, DC. 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.
Pennsylvania· 32nd of 51
$372
HI $933DC $316
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.