go back

Indiana rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,980.61 / $1,980.61 / $1,980.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,980.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $3,784.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,784.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,941.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,353.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,353.19