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Indiana rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.96 / $35.96 / $35.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $35.96 / $36.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.82 / $53.00 / $86.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.82 / $44.51 / $44.94
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.65 / $26.96 / $39.76
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.65 / $25.65 / $39.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $53.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $54.56