How much rates vary
Facilitymedian $219 · 10th to 90th $182 to $1,905Professionalmedian $182 · 10th to 90th $148 to $355
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 $165.96 Median $165.96 Typical High $173.78 | Facility | None | $165.96 | $165.96 | $173.78 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $165.96 Typical High $181.97 | Professional | None | $162.18 | $165.96 | $181.97 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $81.28 Median $83.18 Typical High $91.20 | Professional | 52 · Reduced service | $81.28 | $83.18 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $33.11 Typical High $36.31 | Professional | 53 · Discontinued | $32.36 | $33.11 | $36.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $25.12 Typical High $27.54 | Professional | 55 · Aftercare only | $24.55 | $25.12 | $27.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $16.60 Typical High $18.20 | Professional | 56 · Pre-op care only | $16.22 | $16.60 | $18.20 |
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 $281.84 Median $281.84 Typical High $302.00 | Professional | None | $281.84 | $281.84 | $302.00 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $331.13 Median $371.54 Typical High $371.54 | Professional | 50 · Both sides | $331.13 | $371.54 | $371.54 |
Cigna Setting Facility Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Facility | None | $204.17 | $204.17 | $204.17 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $147.91 Typical High $1,819.70 | Professional | None | $147.91 | $147.91 | $1,819.70 |
Emblem Health Setting Professional Modifier None Typical Low $316.23 Median $501.19 Typical High $575.44 | Professional | None | $316.23 | $501.19 | $575.44 |
Geisinger Setting Facility Modifier None Typical Low $380.19 Median $380.19 Typical High $380.19 | Facility | None | $380.19 | $380.19 | $380.19 |
Geisinger Setting Professional Modifier None Typical Low $194.98 Median $229.09 Typical High $380.19 | Professional | None | $194.98 | $229.09 | $380.19 |
Martin's Point Setting Facility Modifier None Typical Low $165.96 Median $165.96 Typical High $165.96 | Facility | None | $165.96 | $165.96 | $165.96 |
Martin's Point Setting Professional Modifier None Typical Low $162.18 Median $165.96 Typical High $181.97 | Professional | None | $162.18 | $165.96 | $181.97 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $81.28 Median $83.18 Typical High $91.20 | Professional | 52 · Reduced service | $81.28 | $83.18 | $91.20 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $33.11 Typical High $36.31 | Professional | 53 · Discontinued | $32.36 | $33.11 | $36.31 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $25.12 Typical High $27.54 | Professional | 55 · Aftercare only | $24.55 | $25.12 | $27.54 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $16.60 Typical High $18.20 | Professional | 56 · Pre-op care only | $16.22 | $16.60 | $18.20 |
Oscar Health Setting Professional Modifier None Typical Low $208.93 Median $478.63 Typical High $512.86 | Professional | None | $208.93 | $478.63 | $512.86 |
UPMC Health Plan Setting Facility Modifier None Typical Low $257.04 Median $1,174.90 Typical High $1,995.26 | Facility | None | $257.04 | $1,174.90 | $1,995.26 |
UPMC Health Plan Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $354.81 | Professional | None | $257.04 | $257.04 | $354.81 |
United Setting Facility Modifier None Typical Low $181.97 Median $218.78 Typical High $537.03 | Facility | None | $181.97 | $218.78 | $537.03 |
United Setting Professional Modifier None Typical Low $162.18 Median $186.21 Typical High $309.03 | Professional | None | $162.18 | $186.21 | $309.03 |
1 more rate 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 |
|---|---|---|---|---|---|
Highmark BCBS Setting Professional Modifier K3 · Prosthesis level 3 Typical Low $275.42 Median $275.42 Typical High $275.42 | Professional | K3 · Prosthesis level 3 | $275.42 | $275.42 | $275.42 |
Where Pennsylvania sits
The same service costs 3.3 times more in Hawaii than in Delaware. 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· 45th of 51
$186
HI $501DE $151
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.