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Illinois rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $22.95 / $30.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $22.95 / $24.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.35 / $73.75 / $227.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.50 / $13.50 / $13.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.28 / $39.70 / $160.00
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
$23.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $30.44