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Illinois rates for HCPCS Q4256

MLG-Complete, 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 / $741.31 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $891.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $208.93 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $977.24
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $1,023.29 / $2,089.30
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
$954.99 / $954.99 / $954.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,548.82 / $1,548.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $933.25 / $1,862.09