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Illinois rates for HCPCS A2004

Misc W/Motor Score 12-32

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.48 / $12.48 / $130.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.48 / $12.48 / $13.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.26 / $13.26 / $13.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.26 / $13.26 / $13.26
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $200.00 / $345.40
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
$1,500.00 / $2,500.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $14.25