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Indiana rates for HCPCS A2013

Innovamatrix Fs, Per Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,296.00 / $1,296.00 / $1,296.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.00 / $1,296.00 / $1,312.20
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
$1,147.46 / $1,274.95 / $1,784.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.73 / $1,274.95 / $1,529.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,377.00 / $1,377.00 / $1,377.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $2,025.00