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Ohio rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.54 / $38.54 / $55.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $39.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $43.93 / $74.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.54 / $38.54 / $63.57
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $52.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.36 / $36.36 / $38.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $54.54
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
$38.54 / $38.54 / $74.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.39 / $55.52 / $70.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $49.56