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Ohio rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $326.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $72.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $81.30 / $141.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $120.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $95.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.69 / $66.69 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $117.14
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.00 / $255.00 / $255.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $117.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.04 / $85.24 / $102.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.72 / $89.72 / $89.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $90.92