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Indiana rates for HCPCS A2001

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,215.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,930.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,400.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,180.41 / $1,180.41 / $1,770.62
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,180.41 / $1,180.41 / $1,416.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $1,275.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $1,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,250.00 / $1,250.00 / $1,550.00