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Indiana rates for HCPCS A2012

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $91.20 / $117.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $316.23 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $117.49 / $295.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41,686.94 / $41,686.94 / $63,095.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $154.88 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89