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Illinois rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.37 / $35.96 / $90.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $35.96 / $38.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.76 / $110.12 / $316.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.39 / $18.39 / $18.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $50.99
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.62 / $82.72 / $135.82
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
$32.99 / $62.92 / $67.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $55.02