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Ohio rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.59 / $42.59 / $260.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $42.59 / $45.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $3.08 / $5.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.41 / $64.41 / $78.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $52.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $55.05