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Illinois rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $25.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $21.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.47 / $242.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.95 / $26.34 / $30.42
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.72 / $103.77 / $176.72
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.16 / $14.51 / $24.18