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Indiana rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $2,398.83 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $87.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $223.87 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $50.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $45.71 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $43.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $53.70 / $125.89