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Illinois rates for HCPCS Q4258

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $117.49 / $1,737.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $112.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $208.93 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $89.13 / $93.33
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $102.33 / $165.96
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
$117.49 / $117.49 / $117.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $117.49 / $117.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $128.82 / $1,659.59