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Indiana rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.92 / $98.92 / $109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $107.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $156.69 / $195.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $139.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $146.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $117.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $129.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $146.91