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Illinois rates for HCPCS Q4124

Oasis Tri-Layer Wound Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $15.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.71 / $95.97 / $432.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $9.82
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $3.49 / $65.62
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
$3.24 / $3.24 / $3.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.36 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.73