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Illinois rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.84 / $7,227.36 / $60,614.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $24.89 / $26.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.08 / $189.35 / $570.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $32.92
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.36 / $36.47 / $125.00
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
$30.00 / $30.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $33.01