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Illinois rates for HCPCS Q4254

Novafix DL, 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 / $125.89 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $354.81 / $389.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $208.93 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $741.31 / $933.25
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
$30.20 / $30.20 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $436.52 / $478.63