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Indiana rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.85 / $661.85 / $737.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $720.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,264.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $930.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $982.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $786.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $730.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,310.59