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Ohio rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $93.33 / $162.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $104.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $85.11
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $77.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $107.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $97.72 / $131.83
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $134.90 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $83.18 / $125.89