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Ohio rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $72 · 10th–90th $62$2750%20%10th90th$72Professionalmedian $63 · 10th–90th $62$1260%20%10th90th$63$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
$61.66 / $61.66 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $74.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $77.62 / $154.88
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $85.11
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
$58.88 / $58.88 / $63.10
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $89.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $93.33 / $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
$87.10 / $107.15 / $199.53
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $102.33 / $134.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $125.89