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Illinois rates for HCPCS 14021

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,137.96 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $912.01 / $1,995.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,235.94 / $12,882.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,023.29 / $1,659.59
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,230.27 / $2,691.53
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $891.25 / $1,174.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $2,290.87 / $4,897.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $1,621.81