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Ohio rates for HCPCS Q4253

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

Facilitymedian $87 · 10th–90th $76$3550%20%10th90th$87Professionalmedian $76 · 10th–90th $76$1320%50%90th$76$2.0$10.0$50.0$200.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $87.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $95.50 / $173.78
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $75.86
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $165.96
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $75.86
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $107.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $95.50 / $128.82
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $144.54 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $102.33 / $154.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $131.83