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Illinois rates for HCPCS 40801

Drg Absc Cst Hmtma Vestibule Mouth Comp

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$411.70 / $1,411.00 / $5,091.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.04 / $288.70 / $489.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.56 / $1,664.67 / $3,872.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.94 / $345.36 / $491.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.00 / $620.00 / $643.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.42 / $338.36 / $536.66
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.19 / $418.32 / $829.43
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
$243.67 / $249.95 / $391.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $452.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $900.00 / $3,686.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.45 / $428.20 / $772.45