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Ohio rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $15.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $13.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $14.68 / $24.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $19.45
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $17.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.13 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
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
$12.86 / $12.86 / $12.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $15.92 / $20.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $16.73