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Ohio rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,522.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $674.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $753.59 / $1,297.49
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,114.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $884.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $618.21 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $927.31
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,537.00 / $1,537.00 / $1,537.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,204.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $1,034.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $842.72