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Indiana rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.99 / $12.99 / $14.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $14.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $24.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $18.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $19.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $15.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.85 / $12.86 / $12.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $15.95