go back

Indiana rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.27 / $72.27 / $72.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $72.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $138.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $101.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $107.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $85.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $74.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $85.86