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Indiana rates for HCPCS Q4184

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.84 / $80.84 / $80.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.04 / $80.04 / $80.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.04 / $80.04 / $154.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.04 / $80.04 / $113.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.04 / $80.04 / $120.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.04 / $80.04 / $96.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.04 / $80.04 / $80.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.04 / $80.04 / $500.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.04 / $80.04 / $106.92