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Illinois rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $2,992.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,098.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,241.28 / $3,241.28 / $3,241.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,669.29 / $2,979.56 / $4,469.34
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
$3,873.43 / $3,873.43 / $3,873.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $40.00 / $4,208.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,167.27