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Illinois rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $219 · 10th–90th $151–$1,9500%10%20%10th90th$219Professionalmedian $1,950 · 10th–90th $1,318–$2,2910%20%10th90th$1,950$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $1,949.84 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $2,137.96
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $208.93 / $281.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,290.87 / $2,290.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $239.88 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $181.97
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $1,737.80 / $2,511.89
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,570.40 / $2,570.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $3,311.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,995.26