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Indiana rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $960.00 / $960.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $960.00 / $960.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $100.84 / $960.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.51 / $66.51 / $91.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.51 / $79.81 / $99.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $845.01