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Indiana rates for HCPCS Q4219

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,023.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $316.23 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $234.42 / $954.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $676.08 / $794.33