How much rates vary
Facilitymedian $2,754 · 10th to 90th $2,188 to $17,378Professionalmedian $2,188 · 10th to 90th $1,820 to $4,169
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 $1,949.84 Median $1,949.84 Typical High $2,089.30 | Facility | None | $1,949.84 | $1,949.84 | $2,089.30 |
Aetna Setting Professional Modifier None Typical Low $1,905.46 Median $1,949.84 Typical High $2,137.96 | Professional | None | $1,905.46 | $1,949.84 | $2,137.96 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $954.99 Median $1,000.00 Typical High $1,071.52 | Professional | 52 · Reduced service | $954.99 | $1,000.00 | $1,071.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $380.19 Median $407.38 Typical High $426.58 | Professional | 53 · Discontinued | $380.19 | $407.38 | $426.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $302.00 Typical High $323.59 | Professional | 55 · Aftercare only | $288.40 | $302.00 | $323.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $190.55 Median $199.53 Typical High $213.80 | Professional | 56 · Pre-op care only | $190.55 | $199.53 | $213.80 |
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 $3,311.31 Median $3,311.31 Typical High $3,548.13 | Professional | None | $3,311.31 | $3,311.31 | $3,548.13 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $3,981.07 Median $4,365.16 Typical High $4,365.16 | Professional | 50 · Both sides | $3,981.07 | $4,365.16 | $4,365.16 |
Cigna Setting Facility Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $2,511.89 | Facility | None | $2,511.89 | $2,511.89 | $2,511.89 |
Cigna Setting Professional Modifier None Typical Low $1,819.70 Median $1,819.70 Typical High $21,877.62 | Professional | None | $1,819.70 | $1,819.70 | $21,877.62 |
Emblem Health Setting Professional Modifier None Typical Low $4,073.80 Median $6,456.54 Typical High $7,413.10 | Professional | None | $4,073.80 | $6,456.54 | $7,413.10 |
Geisinger Setting Facility Modifier None Typical Low $4,466.84 Median $4,466.84 Typical High $4,466.84 | Facility | None | $4,466.84 | $4,466.84 | $4,466.84 |
Geisinger Setting Professional Modifier None Typical Low $2,290.87 Median $2,691.53 Typical High $4,466.84 | Professional | None | $2,290.87 | $2,691.53 | $4,466.84 |
Martin's Point Setting Facility Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $1,949.84 | Facility | None | $1,949.84 | $1,949.84 | $1,949.84 |
Martin's Point Setting Professional Modifier None Typical Low $1,905.46 Median $2,089.30 Typical High $2,137.96 | Professional | None | $1,905.46 | $2,089.30 | $2,137.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $954.99 Median $1,023.29 Typical High $1,071.52 | Professional | 52 · Reduced service | $954.99 | $1,023.29 | $1,071.52 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $416.87 Typical High $426.58 | Professional | 53 · Discontinued | $389.05 | $416.87 | $426.58 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $309.03 Typical High $323.59 | Professional | 55 · Aftercare only | $288.40 | $309.03 | $323.59 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $208.93 Typical High $213.80 | Professional | 56 · Pre-op care only | $194.98 | $208.93 | $213.80 |
Oscar Health Setting Professional Modifier None Typical Low $2,691.53 Median $6,309.57 Typical High $6,606.93 | Professional | None | $2,691.53 | $6,309.57 | $6,606.93 |
UPMC Health Plan Setting Facility Modifier None Typical Low $3,162.28 Median $14,125.38 Typical High $24,547.09 | Facility | None | $3,162.28 | $14,125.38 | $24,547.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $3,162.28 Median $3,162.28 Typical High $4,168.69 | Professional | None | $3,162.28 | $3,162.28 | $4,168.69 |
United Setting Facility Modifier None Typical Low $2,187.76 Median $5,495.41 Typical High $6,606.93 | Facility | None | $2,187.76 | $5,495.41 | $6,606.93 |
United Setting Professional Modifier None Typical Low $1,995.26 Median $2,187.76 Typical High $3,630.78 | Professional | None | $1,995.26 | $2,187.76 | $3,630.78 |
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 $3,311.31 Median $3,311.31 Typical High $3,311.31 | Professional | K3 · Prosthesis level 3 | $3,311.31 | $3,311.31 | $3,311.31 |
Where Pennsylvania sits
The same service costs 2.6 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· 48th of 51
$2,188
HI $4,786DE $1,820
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.