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Illinois rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $960.00 / $1,260.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $960.00 / $1,020.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.00 / $333.10 / $1,650.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $200.00 / $345.40
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $837.12