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Ohio rates for HCPCS Q4128

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $6,611.04 / $40,671.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $30.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $75.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $34.69 / $60.97
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $29.91 / $45.16
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $40.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.22 / $28.22 / $29.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.81 / $64.00 / $89.44
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $35.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.91 / $33.77 / $40.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $37.11