How much rates vary
Facilitymedian $490 · 10th to 90th $363 to $3,631Professionalmedian $355 · 10th to 90th $288 to $676
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 $316.23 Median $316.23 Typical High $331.13 | Facility | None | $316.23 | $316.23 | $331.13 |
Aetna Setting Professional Modifier None Typical Low $309.03 Median $316.23 Typical High $346.74 | Professional | None | $309.03 | $316.23 | $346.74 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $154.88 Median $158.49 Typical High $173.78 | Professional | 52 · Reduced service | $154.88 | $158.49 | $173.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $61.66 Median $63.10 Typical High $69.18 | Professional | 53 · Discontinued | $61.66 | $63.10 | $69.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $46.77 Median $46.77 Typical High $51.29 | Professional | 55 · Aftercare only | $46.77 | $46.77 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $30.90 Median $31.62 Typical High $34.67 | Professional | 56 · Pre-op care only | $30.90 | $31.62 | $34.67 |
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 $537.03 Median $562.34 Typical High $575.44 | Professional | None | $537.03 | $562.34 | $575.44 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $630.96 Median $707.95 Typical High $707.95 | Professional | 50 · Both sides | $630.96 | $707.95 | $707.95 |
Cigna Setting Facility Modifier None Typical Low $398.11 Median $398.11 Typical High $398.11 | Facility | None | $398.11 | $398.11 | $398.11 |
Cigna Setting Professional Modifier None Typical Low $288.40 Median $288.40 Typical High $3,467.37 | Professional | None | $288.40 | $288.40 | $3,467.37 |
Emblem Health Setting Professional Modifier None Typical Low $645.65 Median $1,000.00 Typical High $1,174.90 | Professional | None | $645.65 | $1,000.00 | $1,174.90 |
Geisinger Setting Facility Modifier None Typical Low $724.44 Median $724.44 Typical High $724.44 | Facility | None | $724.44 | $724.44 | $724.44 |
Geisinger Setting Professional Modifier None Typical Low $371.54 Median $426.58 Typical High $724.44 | Professional | None | $371.54 | $426.58 | $724.44 |
Martin's Point Setting Facility Modifier None Typical Low $316.23 Median $316.23 Typical High $316.23 | Facility | None | $316.23 | $316.23 | $316.23 |
Martin's Point Setting Professional Modifier None Typical Low $309.03 Median $331.13 Typical High $346.74 | Professional | None | $309.03 | $331.13 | $346.74 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $154.88 Median $165.96 Typical High $173.78 | Professional | 52 · Reduced service | $154.88 | $165.96 | $173.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $61.66 Median $66.07 Typical High $69.18 | Professional | 53 · Discontinued | $61.66 | $66.07 | $69.18 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $46.77 Median $50.12 Typical High $51.29 | Professional | 55 · Aftercare only | $46.77 | $50.12 | $51.29 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $30.90 Median $33.11 Typical High $34.67 | Professional | 56 · Pre-op care only | $30.90 | $33.11 | $34.67 |
Oscar Health Setting Professional Modifier None Typical Low $426.58 Median $707.95 Typical High $1,023.29 | Professional | None | $426.58 | $707.95 | $1,023.29 |
UPMC Health Plan Setting Facility Modifier None Typical Low $489.78 Median $2,238.72 Typical High $3,801.89 | Facility | None | $489.78 | $2,238.72 | $3,801.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $489.78 Median $489.78 Typical High $676.08 | Professional | None | $489.78 | $489.78 | $676.08 |
United Setting Facility Modifier None Typical Low $363.08 Median $851.14 Typical High $1,023.29 | Facility | None | $363.08 | $851.14 | $1,023.29 |
United Setting Professional Modifier None Typical Low $316.23 Median $354.81 Typical High $588.84 | Professional | None | $316.23 | $354.81 | $588.84 |
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 $524.81 Median $524.81 Typical High $575.44 | Professional | K3 · Prosthesis level 3 | $524.81 | $524.81 | $575.44 |
Where Pennsylvania sits
The same service costs 2.8 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· 46th of 51
$355
HI $794DE $288
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.