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Ohio rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $663.63 / $1,164.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $683.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.78 / $717.78 / $717.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $769.81 / $1,324.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $663.63 / $1,002.08
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $895.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.05 / $626.05 / $663.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $939.09
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.00 / $850.00 / $850.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $791.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $853.43