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Indiana rates for HCPCS Q4233

SurFactor or NuDyn, per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,120.10 / $5,120.10 / $5,120.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.50 / $487.50 / $487.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.51 / $66.51 / $86.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.51 / $79.81 / $99.77