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Indiana rates for HCPCS Q4107

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

Facilitymedian $204 · 10th–90th $93–$5130%10%10th90th$204Professionalmedian $83 · 10th–90th $79–$1260%50%10th90th$83$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $81.28 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $81.28 / $85.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $223.87 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $93.33 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $346.74 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $138.04