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Illinois rates for HCPCS A4221

Supplies for maintenance of noninsulin drug infusion catheter, per week (list drugs separately)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $14.99 / $138.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.22 / $15.50 / $23.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.40 / $69.30 / $232.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.60 / $18.89 / $18.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.09 / $15.09 / $19.02
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.41 / $35.06 / $88.94
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
$32.75 / $32.75 / $32.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.41 / $34.26 / $37.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.33 / $22.69