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Indiana rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.89 / $29,715.84 / $92,252.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $24.89 / $25.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $36.69 / $60.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $42.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.41 / $64.41 / $83.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.41 / $77.29 / $96.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $32.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $38.58