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Ohio rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $960.00 / $960.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $960.00 / $1,020.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $960.00 / $960.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.51 / $66.51 / $81.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,200.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.99 / $788.99 / $788.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $979.14