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Ohio rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $91.20 / $162.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $72.44 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $107.15
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $72.44 / $75.86
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $131.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $97.72 / $131.83
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $125.89 / $302.00