How much rates vary
Facilitymedian $2,512 · 10th to 90th $2,239 to $14,454Professionalmedian $1,905 · 10th to 90th $1,585 to $3,388
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 $1,584.89 Median $1,584.89 Typical High $1,659.59 | Facility | None | $1,584.89 | $1,584.89 | $1,659.59 |
Aetna Setting Professional Modifier None Typical Low $1,548.82 Median $1,584.89 Typical High $1,737.80 | Professional | None | $1,548.82 | $1,584.89 | $1,737.80 |
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 |
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 $2,691.53 Median $2,691.53 Typical High $2,884.03 | Professional | None | $2,691.53 | $2,691.53 | $2,884.03 |
Capital Blue Cross Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $2,691.53 Median $3,311.31 Typical High $3,311.31 | Professional | KM · Facial prosthesis, new mold | $2,691.53 | $3,311.31 | $3,311.31 |
Capital Blue Cross Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,122.02 Median $1,412.54 Typical High $1,412.54 | Professional | KN · Facial prosthesis, prior mold | $1,122.02 | $1,412.54 | $1,412.54 |
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 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 None Typical Low $1,905.46 Median $1,905.46 Typical High $16,218.10 | Professional | None | $1,905.46 | $1,905.46 | $16,218.10 |
Cigna 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 |
Cigna 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 |
Emblem Health Setting Professional Modifier None Typical Low $3,235.94 Median $5,128.61 Typical High $5,888.44 | Professional | None | $3,235.94 | $5,128.61 | $5,888.44 |
Geisinger 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 |
Geisinger Setting Professional Modifier None Typical Low $1,862.09 Median $2,137.96 Typical High $3,630.78 | Professional | None | $1,862.09 | $2,137.96 | $3,630.78 |
Geisinger Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $1,778.28 Median $2,041.74 Typical High $3,388.44 | Professional | KM · Facial prosthesis, new mold | $1,778.28 | $2,041.74 | $3,388.44 |
Geisinger Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $741.31 Median $870.96 Typical High $1,445.44 | Professional | KN · Facial prosthesis, prior mold | $741.31 | $870.96 | $1,445.44 |
Highmark BCBS Setting Professional Modifier None Typical Low $2,454.71 Median $2,454.71 Typical High $2,630.27 | Professional | None | $2,454.71 | $2,454.71 | $2,630.27 |
Martin's Point Setting Facility Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $1,584.89 | Facility | None | $1,584.89 | $1,584.89 | $1,584.89 |
Martin's Point Setting Professional Modifier None Typical Low $1,548.82 Median $1,621.81 Typical High $1,737.80 | Professional | None | $1,548.82 | $1,621.81 | $1,737.80 |
Martin's Point 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 |
Martin's Point 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 |
Oscar Health Setting Professional Modifier None Typical Low $3,548.13 Median $4,897.79 Typical High $5,248.07 | Professional | None | $3,548.13 | $4,897.79 | $5,248.07 |
UPMC Health Plan Setting Facility Modifier None Typical Low $2,511.89 Median $11,481.54 Typical High $19,498.45 | Facility | None | $2,511.89 | $11,481.54 | $19,498.45 |
UPMC Health Plan Setting Professional Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $3,388.44 | Professional | None | $2,511.89 | $2,511.89 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $3,162.28 Median $3,162.28 Typical High $3,162.28 | Professional | KM · Facial prosthesis, new mold | $3,162.28 | $3,162.28 | $3,162.28 |
UPMC Health Plan Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $1,348.96 Median $1,348.96 Typical High $1,348.96 | Professional | KN · Facial prosthesis, prior mold | $1,348.96 | $1,348.96 | $1,348.96 |
United Setting Facility Modifier None Typical Low $3,981.07 Median $3,981.07 Typical High $4,786.30 | Facility | None | $3,981.07 | $3,981.07 | $4,786.30 |
United Setting Professional Modifier None Typical Low $1,479.11 Median $1,737.80 Typical High $2,754.23 | Professional | None | $1,479.11 | $1,737.80 | $2,754.23 |
7 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 $229.09 Median $234.42 Typical High $257.04 | Professional | 55 · Aftercare only | $229.09 | $234.42 | $257.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $173.78 Typical High $173.78 | Professional | 56 · Pre-op care only | $134.90 | $173.78 | $173.78 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $3,162.28 Median $3,548.13 Typical High $3,548.13 | Professional | 50 · Both sides | $3,162.28 | $3,548.13 | $3,548.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $245.47 Typical High $257.04 | Professional | 55 · Aftercare only | $229.09 | $245.47 | $257.04 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $144.54 Median $173.78 Typical High $173.78 | Professional | 56 · Pre-op care only | $144.54 | $173.78 | $173.78 |
United Setting Professional Modifier RR · Rental Typical Low $588.84 Median $707.95 Typical High $1,047.13 | Professional | RR · Rental | $588.84 | $707.95 | $1,047.13 |
United Setting Professional Modifier UE · Used equipment Typical Low $1,412.54 Median $1,659.59 Typical High $2,511.89 | Professional | UE · Used equipment | $1,412.54 | $1,659.59 | $2,511.89 |
Where Pennsylvania 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.
Pennsylvania· 33rd 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.