How much rates vary
Facilitymedian $4,266 · 10th to 90th $2,239 to $7,943Professionalmedian $1,905 · 10th to 90th $1,585 to $3,890
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 $1,905.46 Median $1,905.46 Typical High $14,791.08 | Facility | None | $1,905.46 | $1,905.46 | $14,791.08 |
Aetna Setting Professional Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $10,471.29 | Professional | None | $1,905.46 | $1,905.46 | $10,471.29 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,801.89 Median $4,677.35 Typical High $8,511.38 | Facility | None | $3,801.89 | $4,677.35 | $8,511.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,778.28 Median $1,862.09 Typical High $4,265.80 | Professional | None | $1,778.28 | $1,862.09 | $4,265.80 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $177.83 Median $177.83 Typical High $194.98 | Professional | RR · Rental | $177.83 | $177.83 | $194.98 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $1,348.96 Median $1,412.54 Typical High $1,949.84 | Professional | UE · Used equipment | $1,348.96 | $1,412.54 | $1,949.84 |
CareSource Setting Facility Modifier None Typical Low $933.25 Median $1,548.82 Typical High $2,951.21 | Facility | None | $933.25 | $1,548.82 | $2,951.21 |
CareSource Setting Professional Modifier None Typical Low $794.33 Median $1,995.26 Typical High $4,168.69 | Professional | None | $794.33 | $1,995.26 | $4,168.69 |
Cigna Setting Facility Modifier None Typical Low $2,238.72 Median $2,238.72 Typical High $2,238.72 | Facility | None | $2,238.72 | $2,238.72 | $2,238.72 |
Cigna Setting Professional Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $2,238.72 | Professional | None | $1,905.46 | $1,905.46 | $2,238.72 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $2,238.72 Median $2,238.72 Typical High $2,238.72 | Facility | None | $2,238.72 | $2,238.72 | $2,238.72 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $2,238.72 | Professional | None | $1,905.46 | $1,905.46 | $2,238.72 |
Molina Setting Professional Modifier None Typical Low $1,000.00 Median $2,344.23 Typical High $3,162.28 | Professional | None | $1,000.00 | $2,344.23 | $3,162.28 |
SummaCare Setting Professional Modifier None Typical Low $3,981.07 Median $4,073.80 Typical High $6,309.57 | Professional | None | $3,981.07 | $4,073.80 | $6,309.57 |
United Setting Facility Modifier None Typical Low $3,388.44 Median $3,388.44 Typical High $4,786.30 | Facility | None | $3,388.44 | $3,388.44 | $4,786.30 |
United Setting Professional Modifier None Typical Low $1,318.26 Median $1,949.84 Typical High $2,818.38 | Professional | None | $1,318.26 | $1,949.84 | $2,818.38 |
United Setting Professional Modifier RR · Rental Typical Low $524.81 Median $794.33 Typical High $1,148.15 | Professional | RR · Rental | $524.81 | $794.33 | $1,148.15 |
United Setting Professional Modifier UE · Used equipment Typical Low $1,230.27 Median $1,862.09 Typical High $2,691.53 | Professional | UE · Used equipment | $1,230.27 | $1,862.09 | $2,691.53 |
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 $288.40 Median $288.40 Typical High $1,548.82 | Professional | 55 · Aftercare only | $288.40 | $288.40 | $1,548.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $173.78 Median $1,000.00 Typical High $1,479.11 | Professional | 56 · Pre-op care only | $173.78 | $1,000.00 | $1,479.11 |
Aetna Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $912.01 Median $912.01 Typical High $912.01 | Professional | KM · Facial prosthesis, new mold | $912.01 | $912.01 | $912.01 |
Aetna Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $380.19 Median $380.19 Typical High $380.19 | Professional | KN · Facial prosthesis, prior mold | $380.19 | $380.19 | $380.19 |
Anthem BCBS Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $2,951.21 Median $5,011.87 Typical High $9,332.54 | Professional | KM · Facial prosthesis, new mold | $2,951.21 | $5,011.87 | $9,332.54 |
Anthem BCBS Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,258.93 Median $2,089.30 Typical High $3,981.07 | Professional | KN · Facial prosthesis, prior mold | $1,258.93 | $2,089.30 | $3,981.07 |
Cigna Setting Facility Modifier KM · Facial prosthesis, new mold Typical Low $2,511.89 Median $2,511.89 Typical High $2,511.89 | Facility | KM · Facial prosthesis, new mold | $2,511.89 | $2,511.89 | $2,511.89 |
Cigna Setting Facility Modifier KN · Facial prosthesis, prior mold Typical Low $1,047.13 Median $1,047.13 Typical High $1,047.13 | Facility | KN · Facial prosthesis, prior mold | $1,047.13 | $1,047.13 | $1,047.13 |
Cigna Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $2,511.89 Median $2,511.89 Typical High $2,951.21 | Professional | KM · Facial prosthesis, new mold | $2,511.89 | $2,511.89 | $2,951.21 |
Cigna Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,047.13 Median $1,047.13 Typical High $1,258.93 | Professional | KN · Facial prosthesis, prior mold | $1,047.13 | $1,047.13 | $1,258.93 |
Medical Mutual of Ohio Setting Facility Modifier KM · Facial prosthesis, new mold Typical Low $2,511.89 Median $2,511.89 Typical High $2,511.89 | Facility | KM · Facial prosthesis, new mold | $2,511.89 | $2,511.89 | $2,511.89 |
Medical Mutual of Ohio Setting Facility Modifier KN · Facial prosthesis, prior mold Typical Low $1,047.13 Median $1,047.13 Typical High $1,047.13 | Facility | KN · Facial prosthesis, prior mold | $1,047.13 | $1,047.13 | $1,047.13 |
Medical Mutual of Ohio Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $2,511.89 Median $2,511.89 Typical High $2,511.89 | Professional | KM · Facial prosthesis, new mold | $2,511.89 | $2,511.89 | $2,511.89 |
Medical Mutual of Ohio Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,047.13 Median $1,047.13 Typical High $1,047.13 | Professional | KN · Facial prosthesis, prior mold | $1,047.13 | $1,047.13 | $1,047.13 |
SummaCare Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $3,801.89 Median $3,890.45 Typical High $6,025.60 | Professional | KM · Facial prosthesis, new mold | $3,801.89 | $3,890.45 | $6,025.60 |
SummaCare Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,621.81 Median $1,621.81 Typical High $2,511.89 | Professional | KN · Facial prosthesis, prior mold | $1,621.81 | $1,621.81 | $2,511.89 |
Where Ohio sits
The same service costs 2.1 times more in Wisconsin than in Kentucky. 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· 28th of 51
$1,905
WI $3,715KY $1,778
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.