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Indiana rates for HCPCS 14021

Adjt/Rearrgmt Scalp/Arm/Leg 10.1-30.0 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.64 / $2,409.42 / $11,093.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.64 / $716.04 / $904.79
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.73 / $718.73 / $718.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.00 / $5,948.00 / $9,462.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.16 / $733.13 / $1,054.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$576.35 / $839.50 / $1,073.03
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.81 / $947.77 / $1,126.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.83 / $1,314.83 / $1,314.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.50 / $885.31 / $1,335.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $3,870.00 / $5,490.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.67 / $903.90 / $1,350.72