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Illinois rates for HCPCS Q4247

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,750.87 / $2,944.00 / $2,944.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,944.00 / $2,944.00 / $3,128.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.99 / $482.99 / $601.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.40 / $745.83 / $941.93
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
$3,200.00 / $3,200.00 / $3,328.96