How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $0.20 Median $0.20 Typical High $1.00 | Facility | None | $0.20 | $0.20 | $1.00 |
Aetna Setting Professional Modifier None Typical Low $0.20 Median $0.20 Typical High $0.27 | Professional | None | $0.20 | $0.20 | $0.27 |
Ambetter Setting Professional Modifier None Typical Low $23.99 Median $23.99 Typical High $23.99 | Professional | None | $23.99 | $23.99 | $23.99 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.21 Median $0.46 Typical High $1.45 | Professional | None | $0.21 | $0.46 | $1.45 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.17 Median $0.21 Typical High $0.28 | Professional | UE · Used equipment | $0.17 | $0.21 | $0.28 |
CareSource Setting Facility Modifier None Typical Low $0.65 Median $0.65 Typical High $0.69 | Facility | None | $0.65 | $0.65 | $0.69 |
CareSource Setting Professional Modifier None Typical Low $0.28 Median $0.39 Typical High $0.65 | Professional | None | $0.28 | $0.39 | $0.65 |
Cigna Setting Professional Modifier None Typical Low $0.26 Median $0.26 Typical High $0.26 | Professional | None | $0.26 | $0.26 | $0.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.26 Median $0.26 Typical High $0.26 | Professional | None | $0.26 | $0.26 | $0.26 |
Molina Setting Professional Modifier None Typical Low $0.26 Median $0.35 Typical High $0.52 | Professional | None | $0.26 | $0.35 | $0.52 |
United Setting Professional Modifier None Typical Low $0.18 Median $0.27 Typical High $0.34 | Professional | None | $0.18 | $0.27 | $0.34 |
8 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 $0.03 Median $0.03 Typical High $0.04 | Professional | 55 · Aftercare only | $0.03 | $0.03 | $0.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.02 Median $0.02 Typical High $0.03 | Professional | 56 · Pre-op care only | $0.02 | $0.02 | $0.03 |
Aetna Setting Professional Modifier AW · With surgical dressing Typical Low $0.15 Median $0.15 Typical High $0.15 | Professional | AW · With surgical dressing | $0.15 | $0.15 | $0.15 |
Ambetter Setting Professional Modifier AW · With surgical dressing Typical Low $40.74 Median $40.74 Typical High $40.74 | Professional | AW · With surgical dressing | $40.74 | $40.74 | $40.74 |
Anthem BCBS Setting Professional Modifier AW · With surgical dressing Typical Low $0.54 Median $0.74 Typical High $1.23 | Professional | AW · With surgical dressing | $0.54 | $0.74 | $1.23 |
SummaCare Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $0.43 Median $0.50 Typical High $0.69 | Professional | AU · Urologic/ostomy supply | $0.43 | $0.50 | $0.69 |
SummaCare Setting Professional Modifier AV · With prosthetic/orthotic Typical Low $0.48 Median $0.50 Typical High $0.69 | Professional | AV · With prosthetic/orthotic | $0.48 | $0.50 | $0.69 |
SummaCare Setting Professional Modifier AW · With surgical dressing Typical Low $0.46 Median $0.54 Typical High $0.74 | Professional | AW · With surgical dressing | $0.46 | $0.54 | $0.74 |
Where Ohio sits
The same service costs 2.5 times more in Montana than in Colorado. 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· 40th of 51
$0.26
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.