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Ohio rates for HCPCS Q4247

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$878.00 / $2,944.00 / $2,944.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,944.00 / $2,944.00 / $3,128.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.00 / $609.50 / $907.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.50 / $715.50 / $1,216.34
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.00 / $715.50 / $715.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,212.09 / $1,212.09 / $1,212.09
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.00 / $583.00 / $874.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,200.00 / $3,200.00 / $4,166.39