How much rates vary
Facilitymedian $427 · 10th to 90th $331 to $2,455Professionalmedian $347 · 10th to 90th $309 to $692
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 $309.03 Median $309.03 Typical High $323.59 | Facility | None | $309.03 | $309.03 | $323.59 |
Aetna Setting Professional Modifier None Typical Low $302.00 Median $309.03 Typical High $338.84 | Professional | None | $302.00 | $309.03 | $338.84 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $151.36 Median $162.18 Typical High $169.82 | Professional | 52 · Reduced service | $151.36 | $162.18 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $60.26 Median $64.57 Typical High $67.61 | Professional | 53 · Discontinued | $60.26 | $64.57 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $44.67 Median $47.86 Typical High $50.12 | Professional | 55 · Aftercare only | $44.67 | $47.86 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $30.20 Median $32.36 Typical High $33.88 | Professional | 56 · Pre-op care only | $30.20 | $32.36 | $33.88 |
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 $549.54 Median $691.83 Typical High $691.83 | Professional | None | $549.54 | $691.83 | $691.83 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $426.58 Typical High $426.58 | Facility | None | $426.58 | $426.58 | $426.58 |
Cigna Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $3,801.89 | Professional | None | $309.03 | $309.03 | $3,801.89 |
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 $707.95 Median $707.95 Typical High $707.95 | Facility | None | $707.95 | $707.95 | $707.95 |
Geisinger Setting Professional Modifier None Typical Low $363.08 Median $416.87 Typical High $707.95 | Professional | None | $363.08 | $416.87 | $707.95 |
Martin's Point Setting Facility Modifier None Typical Low $309.03 Median $309.03 Typical High $309.03 | Facility | None | $309.03 | $309.03 | $309.03 |
Martin's Point Setting Professional Modifier None Typical Low $302.00 Median $323.59 Typical High $338.84 | Professional | None | $302.00 | $323.59 | $338.84 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $151.36 Median $162.18 Typical High $169.82 | Professional | 52 · Reduced service | $151.36 | $162.18 | $169.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $61.66 Median $64.57 Typical High $67.61 | Professional | 53 · Discontinued | $61.66 | $64.57 | $67.61 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $45.71 Median $48.98 Typical High $50.12 | Professional | 55 · Aftercare only | $45.71 | $48.98 | $50.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $30.90 Median $32.36 Typical High $33.88 | Professional | 56 · Pre-op care only | $30.90 | $32.36 | $33.88 |
Oscar Health Setting Professional Modifier None Typical Low $426.58 Median $977.24 Typical High $1,023.29 | Professional | None | $426.58 | $977.24 | $1,023.29 |
UPMC Health Plan Setting Facility Modifier None Typical Low $331.13 Median $1,479.11 Typical High $2,570.40 | Facility | None | $331.13 | $1,479.11 | $2,570.40 |
UPMC Health Plan Setting Professional Modifier None Typical Low $331.13 Median $331.13 Typical High $660.69 | Professional | None | $331.13 | $331.13 | $660.69 |
United Setting Facility Modifier None Typical Low $426.58 Median $457.09 Typical High $1,122.02 | Facility | None | $426.58 | $457.09 | $1,122.02 |
United Setting Professional Modifier None Typical Low $309.03 Median $346.74 Typical High $575.44 | Professional | None | $309.03 | $346.74 | $575.44 |
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 $616.60 Median $691.83 Typical High $691.83 | Professional | 50 · Both sides | $616.60 | $691.83 | $691.83 |
Highmark BCBS Setting Professional Modifier K3 · Prosthesis level 3 + KX · Policy requirements met Typical Low $512.86 Median $512.86 Typical High $512.86 | Professional | K3 · Prosthesis level 3 + KX · Policy requirements met | $512.86 | $512.86 | $512.86 |
Where Pennsylvania sits
The same service costs 3.8 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· 48th of 51
$347
HI $1,175DE $309
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.