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Ohio rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,512.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $757.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $852.65 / $1,427.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,109.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $992.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.44 / $693.44 / $735.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,040.16
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,887.00 / $1,887.00 / $1,887.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,340.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.55 / $975.85 / $1,215.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $939.39