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Ohio rates for HCPCS Q4196

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $338.84 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $120.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $120.23 / $131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $120.23 / $190.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $144.54
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $100.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $173.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $112.20 / $147.91
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $134.90 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $125.89 / $165.96