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Indiana rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.59 / $42.59 / $42.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $42.59 / $43.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $3.75 / $34.18
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
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $66.54