go back

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
$30.53 / $2,420.00 / $2,645.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $31.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $35.65 / $58.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $42.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $46.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $36.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $43.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $40.38