go back

Ohio rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.96 / $35.96 / $70.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $35.96 / $38.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $50.33 / $76.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.34 / $25.34 / $41.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.34 / $25.34 / $25.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $50.99
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $63.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $56.17 / $65.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $66.73