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Ohio rates for HCPCS Q4142

XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $115 · 10th–90th $81–$3160%20%10th90th$115Professionalmedian $115 · 10th–90th $41–$1350%20%10th90th$115$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$81.28 / $81.28 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $117.49 / $134.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $147.91
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
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $138.04
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $50.12 / $60.26
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
$117.49 / $144.54 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $125.89 / $125.89