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Ohio rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.00 / $1,969.89 / $1,969.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,028.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $2,251.96 / $3,900.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,974.53
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,659.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.38 / $1,858.38 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,701.20
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,296.02 / $2,296.02 / $2,296.02
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,701.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $50.00 / $1,968.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,702.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,517.52