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Illinois rates for HCPCS Q4158

Kerecis Omega3, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.27 / $74.34 / $644.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $74.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.96 / $330.60 / $1,443.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.02 / $72.02 / $78.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $85.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.04 / $94.18 / $327.68
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
$87.45 / $87.45 / $87.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $40.00 / $93.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $73.75