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Ohio rates for HCPCS Q4110

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $65.41 / $80.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $67.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $73.91 / $127.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $65.41 / $98.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $88.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.70 / $61.70 / $65.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.40 / $65.40 / $92.55
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
$65.40 / $65.40 / $94.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $81.76 / $94.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $84.12