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Ohio rates for HCPCS Q4151

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $134.88 / $279.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $138.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $155.12 / $261.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $134.88 / $203.68
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $182.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.25 / $127.25 / $134.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $137.19
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.35 / $140.35 / $140.35
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $159.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.19 / $168.61 / $197.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $175.63