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Illinois rates for HCPCS Q4203

Derma-gide, 1 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.90 / $1,052.89 / $1,052.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,095.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.00 / $1,052.89 / $1,052.89
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.55 / $1,052.89 / $1,579.34
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
$1,368.76 / $1,368.76 / $1,368.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $40.00 / $441.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,117.11