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Ohio rates for HCPCS Q4115

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

Facilitymedian $15 · 10th–90th $12$2750%20%10th90th$15Professionalmedian $13 · 10th–90th $12$1260%20%40%10th90th$13$2.0$5.0$10.0$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $15.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.85 / $138.04
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $17.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.88
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $14.45
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $87.10 / $128.82
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $134.90 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $125.89 / $125.89