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Illinois rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $549.54 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $208.93 / $275.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $741.31
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $776.25 / $1,513.56
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
$724.44 / $724.44 / $724.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $4,570.88 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,398.83 / $2,818.38