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Indiana rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.07 / $107.77 / $107.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $107.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.70 / $106.70 / $205.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $151.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.70 / $106.70 / $160.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $128.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.70 / $106.70 / $106.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $373.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $160.05