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Illinois rates for HCPCS Q4104

Integra Bilayer Matrix Wound Dressing (Bmwd) Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.73 / $51.00 / $85.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $53.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.00 / $69.80 / $590.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $60.14
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.35 / $58.65 / $123.57
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
$66.30 / $66.30 / $66.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $40.00 / $73.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.39 / $51.00 / $55.14