go back

Illinois rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $200 · 10th–90th $98$26,9150%10%10th90th$200Professionalmedian $100 · 10th–90th $95$1260%20%40%10th90th$100$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $165.96 / $46,773.51
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $100.00 / $120.23
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $218.78 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $239.88 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $169.82 / $346.74
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $199.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89