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 $0.28 Median $0.28 Typical High $1.00 | Facility | None | $0.28 | $0.28 | $1.00 |
Aetna Setting Professional Modifier None Typical Low $0.28 Median $0.28 Typical High $0.34 | Professional | None | $0.28 | $0.28 | $0.34 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.22 Median $0.59 Typical High $0.76 | Professional | None | $0.22 | $0.59 | $0.76 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.16 Median $0.18 Typical High $0.25 | Professional | UE · Used equipment | $0.16 | $0.18 | $0.25 |
CareSource Setting Facility Modifier None Typical Low $0.56 Median $0.56 Typical High $0.56 | Facility | None | $0.56 | $0.56 | $0.56 |
CareSource Setting Professional Modifier None Typical Low $0.56 Median $0.56 Typical High $0.59 | Professional | None | $0.56 | $0.56 | $0.59 |
Cigna Setting Professional Modifier None Typical Low $0.22 Median $0.22 Typical High $0.22 | Professional | None | $0.22 | $0.22 | $0.22 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $0.85 Median $0.85 Typical High $0.85 | Facility | None | $0.85 | $0.85 | $0.85 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.22 Median $0.22 Typical High $0.22 | Professional | None | $0.22 | $0.22 | $0.22 |
Molina Setting Professional Modifier None Typical Low $0.21 Median $0.29 Typical High $0.43 | Professional | None | $0.21 | $0.29 | $0.43 |
SummaCare Setting Professional Modifier None Typical Low $0.38 Median $0.45 Typical High $0.62 | Professional | None | $0.38 | $0.45 | $0.62 |
United Setting Professional Modifier None Typical Low $0.15 Median $0.22 Typical High $0.27 | Professional | None | $0.15 | $0.22 | $0.27 |
5 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 52 · Reduced service Typical Low $0.14 Median $0.14 Typical High $0.17 | Professional | 52 · Reduced service | $0.14 | $0.14 | $0.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.06 Median $0.06 Typical High $0.07 | Professional | 53 · Discontinued | $0.06 | $0.06 | $0.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.04 Median $0.04 Typical High $0.05 | Professional | 55 · Aftercare only | $0.04 | $0.04 | $0.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.03 Typical High $0.04 | Professional | 56 · Pre-op care only | $0.03 | $0.03 | $0.04 |
Ambetter Setting Professional Modifier A1 · Dressing, 1 wound Typical Low $33.88 Median $33.88 Typical High $33.88 | Professional | A1 · Dressing, 1 wound | $33.88 | $33.88 | $33.88 |
Where Ohio sits
The same service costs 2.5 times more in Hawaii than in Utah. 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· 44th of 51
$0.22
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.