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Ohio rates for HCPCS Q4101

Apligraf, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $378.84 / $3,639.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $90.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $35.06 / $60.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $46.25
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $40.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $28.52 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $42.78
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.49 / $85.00 / $146.44
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $49.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.30 / $37.78 / $43.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $39.36