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Illinois rates for HCPCS Q4199

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $117.49 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $134.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $208.93 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $158.49
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $199.53 / $537.03
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
$144.54 / $144.54 / $144.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $549.54 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $309.03 / $398.11