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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
$30.20 / $9,549.93 / $38,018.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $25.12 / $30.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $223.87 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $50.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $52.48 / $125.89