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Illinois rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $15.85 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $13.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $194.98 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $10.00 / $19.95
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
$10.23 / $10.23 / $10.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $12.59 / $12.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $8.51 / $125.89