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Indiana rates for HCPCS Q4110

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.06 / $66.06 / $66.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $66.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $77.13 / $126.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $92.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $65.41 / $98.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $78.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.40 / $65.40 / $65.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.98 / $65.40 / $80.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $85.28