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Illinois rates for HCPCS 80376

Drug/Substance Definitive Qual/Quant Nos 4-6

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $21.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $21.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.54 / $2.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.47 / $242.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.81 / $24.59 / $33.29
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.37 / $111.51 / $189.90
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 / $14.44 / $24.18