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Indiana rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.90 / $80.90 / $80.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $80.90 / $81.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.59 / $109.19 / $178.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.59 / $92.59 / $131.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.41 / $84.53 / $100.78
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.02 / $69.08 / $97.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $119.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $146.16