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Ohio rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $187.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $100.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $154.84 / $244.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $111.84 / $190.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $166.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $132.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.40 / $92.40 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $138.59
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.44 / $175.44 / $175.44
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $177.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $122.42 / $151.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $121.54