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Indiana rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $645.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $380.19 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $891.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $831.76 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $4,570.88 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,290.87 / $2,691.53