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Ohio rates for HCPCS Q4258

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $107.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $109.65 / $190.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $125.89
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $89.13
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $154.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $102.33 / $134.90
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $134.90 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $125.89 / $1,659.59