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Illinois rates for HCPCS Q4141

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.97 / $106.97 / $117.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $112.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.97 / $106.97 / $106.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $112.05
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.92 / $117.67 / $259.19
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
$139.06 / $139.06 / $139.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $40.00 / $55.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.97 / $106.97 / $113.50