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Illinois rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.54 / $38.54 / $78.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $42.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.40 / $106.79 / $520.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $49.19
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.31 / $48.95 / $93.38
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
$50.10 / $50.10 / $50.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $40.00 / $74.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $42.25