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Illinois rates for HCPCS Q4139

Amniomatrix Or Biodmatrix Injectable 1 Cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $640.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.00 / $640.00 / $1,820.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.40 / $992.70 / $1,253.70
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 / $40.00 / $2,500.00