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Illinois rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $182 · 10th–90th $2–$2570%10%10th90th$182Professionalmedian $2 · 10th–90th $2–$1170%50%90th$2$2.0$10.0$50.0$200.0

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
$2.00 / $15.85 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $7.94
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $204.17 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $208.93 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $125.89 / $125.89
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $40.74 / $85.11
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.24 / $3.24 / $3.24
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
$15.14 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $125.89 / $125.89