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Ohio rates for HCPCS Q4233

SurFactor or NuDyn, per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,128.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $60.26 / $75.86