How much rates vary
Facilitymedian $4,898 · 10th to 90th $3,631 to $8,913Professionalmedian $2,455 · 10th to 90th $1,820 to $4,898
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 $2,238.72 Median $2,238.72 Typical High $10,964.78 | Facility | None | $2,238.72 | $2,238.72 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $2,238.72 Median $2,238.72 Typical High $7,585.78 | Professional | None | $2,238.72 | $2,238.72 | $7,585.78 |
Anthem BCBS Setting Facility Modifier None Typical Low $4,365.16 Median $5,370.32 Typical High $10,000.00 | Facility | None | $4,365.16 | $5,370.32 | $10,000.00 |
Anthem BCBS Setting Professional Modifier None Typical Low $2,137.96 Median $2,454.71 Typical High $5,888.44 | Professional | None | $2,137.96 | $2,454.71 | $5,888.44 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $245.47 Median $245.47 Typical High $269.15 | Professional | RR · Rental | $245.47 | $245.47 | $269.15 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $1,621.81 Median $1,819.70 Typical High $2,398.83 | Professional | UE · Used equipment | $1,621.81 | $1,819.70 | $2,398.83 |
CareSource Setting Facility Modifier None Typical Low $1,348.96 Median $2,238.72 Typical High $4,265.80 | Facility | None | $1,348.96 | $2,238.72 | $4,265.80 |
CareSource Setting Professional Modifier None Typical Low $1,148.15 Median $2,884.03 Typical High $6,025.60 | Professional | None | $1,148.15 | $2,884.03 | $6,025.60 |
Cigna Setting Facility Modifier None Typical Low $3,630.78 Median $3,630.78 Typical High $3,630.78 | Facility | None | $3,630.78 | $3,630.78 | $3,630.78 |
Cigna Setting Professional Modifier None Typical Low $3,090.30 Median $3,090.30 Typical High $3,630.78 | Professional | None | $3,090.30 | $3,090.30 | $3,630.78 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $3,630.78 Median $3,630.78 Typical High $3,630.78 | Facility | None | $3,630.78 | $3,630.78 | $3,630.78 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $3,090.30 Median $3,090.30 Typical High $3,630.78 | Professional | None | $3,090.30 | $3,090.30 | $3,630.78 |
Molina Setting Professional Modifier None Typical Low $1,445.44 Median $3,388.44 Typical High $4,570.88 | Professional | None | $1,445.44 | $3,388.44 | $4,570.88 |
SummaCare Setting Professional Modifier None Typical Low $4,677.35 Median $4,677.35 Typical High $7,244.36 | Professional | None | $4,677.35 | $4,677.35 | $7,244.36 |
United Setting Facility Modifier None Typical Low $4,677.35 Median $4,677.35 Typical High $6,606.93 | Facility | None | $4,677.35 | $4,677.35 | $6,606.93 |
United Setting Professional Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,311.31 | Professional | None | $1,513.56 | $2,238.72 | $3,311.31 |
United Setting Professional Modifier RR · Rental Typical Low $602.56 Median $912.01 Typical High $1,318.26 | Professional | RR · Rental | $602.56 | $912.01 | $1,318.26 |
United Setting Professional Modifier UE · Used equipment Typical Low $1,445.44 Median $2,137.96 Typical High $3,090.30 | Professional | UE · Used equipment | $1,445.44 | $2,137.96 | $3,090.30 |
16 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 |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $331.13 Median $331.13 Typical High $1,122.02 | Professional | 55 · Aftercare only | $331.13 | $331.13 | $1,122.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $257.04 Median $758.58 Typical High $1,096.48 | Professional | 56 · Pre-op care only | $257.04 | $758.58 | $1,096.48 |
Aetna Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $1,230.27 Median $1,230.27 Typical High $1,230.27 | Professional | KM · Facial prosthesis, new mold | $1,230.27 | $1,230.27 | $1,230.27 |
Aetna Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $524.81 Median $524.81 Typical High $524.81 | Professional | KN · Facial prosthesis, prior mold | $524.81 | $524.81 | $524.81 |
Anthem BCBS Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $3,388.44 Median $5,754.40 Typical High $10,964.78 | Professional | KM · Facial prosthesis, new mold | $3,388.44 | $5,754.40 | $10,964.78 |
Anthem BCBS Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,445.44 Median $2,398.83 Typical High $4,570.88 | Professional | KN · Facial prosthesis, prior mold | $1,445.44 | $2,398.83 | $4,570.88 |
Cigna Setting Facility Modifier KM · Facial prosthesis, new mold Typical Low $3,388.44 Median $3,388.44 Typical High $3,388.44 | Facility | KM · Facial prosthesis, new mold | $3,388.44 | $3,388.44 | $3,388.44 |
Cigna Setting Facility Modifier KN · Facial prosthesis, prior mold Typical Low $1,445.44 Median $1,445.44 Typical High $1,445.44 | Facility | KN · Facial prosthesis, prior mold | $1,445.44 | $1,445.44 | $1,445.44 |
Cigna Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $3,388.44 Median $3,388.44 Typical High $3,548.13 | Professional | KM · Facial prosthesis, new mold | $3,388.44 | $3,388.44 | $3,548.13 |
Cigna Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,445.44 Median $1,445.44 Typical High $1,513.56 | Professional | KN · Facial prosthesis, prior mold | $1,445.44 | $1,445.44 | $1,513.56 |
Medical Mutual of Ohio Setting Facility Modifier KM · Facial prosthesis, new mold Typical Low $3,388.44 Median $3,388.44 Typical High $3,388.44 | Facility | KM · Facial prosthesis, new mold | $3,388.44 | $3,388.44 | $3,388.44 |
Medical Mutual of Ohio Setting Facility Modifier KN · Facial prosthesis, prior mold Typical Low $1,445.44 Median $1,445.44 Typical High $1,445.44 | Facility | KN · Facial prosthesis, prior mold | $1,445.44 | $1,445.44 | $1,445.44 |
Medical Mutual of Ohio Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $3,388.44 Median $3,388.44 Typical High $3,388.44 | Professional | KM · Facial prosthesis, new mold | $3,388.44 | $3,388.44 | $3,388.44 |
Medical Mutual of Ohio Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,445.44 Median $1,445.44 Typical High $1,445.44 | Professional | KN · Facial prosthesis, prior mold | $1,445.44 | $1,445.44 | $1,445.44 |
SummaCare Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $4,365.16 Median $4,466.84 Typical High $6,918.31 | Professional | KM · Facial prosthesis, new mold | $4,365.16 | $4,466.84 | $6,918.31 |
SummaCare Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,862.09 Median $1,862.09 Typical High $2,951.21 | Professional | KN · Facial prosthesis, prior mold | $1,862.09 | $1,862.09 | $2,951.21 |
Where Ohio sits
The same service costs 2.0 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.
Ohio· 43rd of 51
$2,512
HI $4,898DC $2,399
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.