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Illinois rates for HCPCS 15276

Sub Grft F/S/N/H/F/G/M/D<100sq Cm Ea Addl25sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.36 / $1,094.00 / $5,091.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $29.26 / $51.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.37 / $278.88 / $558.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.30 / $38.20 / $55.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.58 / $39.24 / $57.18
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.23 / $49.98 / $166.12
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
$29.11 / $31.41 / $44.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $51.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $1,032.00 / $3,686.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.83 / $47.05 / $75.14