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Illinois rates for HCPCS Q4248

Dermacyte amniotic membrane allograft, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.20 / $555.20 / $2,829.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.20 / $555.20 / $644.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,166.54 / $3,166.54 / $3,166.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.20 / $555.20 / $555.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.20 / $555.20 / $733.29
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.92 / $705.10 / $1,416.32
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
$721.76 / $721.76 / $721.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $40.00 / $4,111.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.20 / $555.20 / $608.69