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Indiana rates for HCPCS Q4235

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.29 / $88.86 / $88.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $88.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.98 / $87.98 / $169.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $124.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.98 / $87.98 / $131.97
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $101.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $94.23