go back

Indiana rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.19 / $7.95 / $7.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $15.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.67 / $7.87 / $10.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.43