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Indiana rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $22.95 / $22.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $22.95 / $23.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.45 / $20.45 / $32.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $16.91 / $31.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.41 / $64.41 / $93.03
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.41 / $64.41 / $77.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $48.77