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Indiana rates for HCPCS 01922

Anesthesia for non-invasive imaging or radiation therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $616.60 / $724.44
Aetna
Facility/Professional
Professional
Modifier
AA
Low / Median / High Price
$616.60 / $1,096.48 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
QK
Low / Median / High Price
$380.19 / $549.54 / $776.25
Aetna
Facility/Professional
Professional
Modifier
QX
Low / Median / High Price
$416.87 / $562.34 / $812.83
Aetna
Facility/Professional
Professional
Modifier
QZ
Low / Median / High Price
$501.19 / $602.56 / $1,122.02
Ambetter
Facility/Professional
Professional
Modifier
AA
Low / Median / High Price
$199.53 / $302.00 / $870.96
Ambetter
Facility/Professional
Professional
Modifier
QK
Low / Median / High Price
$89.13 / $107.15 / $275.42
Ambetter
Facility/Professional
Professional
Modifier
QX
Low / Median / High Price
$97.72 / $131.83 / $177.83
Ambetter
Facility/Professional
Professional
Modifier
QZ
Low / Median / High Price
$302.00 / $512.86 / $758.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $102.33 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10