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Ohio rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $9.05 / $15.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.88
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $10.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.43 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
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
$7.87 / $7.87 / $9.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.33 / $8.90 / $11.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.77