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Ohio rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $691.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $602.56 / $1,047.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $794.33
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $549.54
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $977.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $131.83 / $912.01
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
$125.89 / $2,691.53 / $2,818.38