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Illinois rates for HCPCS A2009

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.67 / $54.67 / $54.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.52 / $54.67 / $90.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.13 / $93.13 / $93.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.13 / $93.13 / $93.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $200.00 / $345.40
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.00 / $2,500.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.30 / $91.30 / $103.17