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Illinois rates for HCPCS A4223

Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.86 / $297.04 / $594.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.55 / $35.84 / $35.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $18.70 / $18.70
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.80 / $118.70 / $160.00
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
$16.84 / $30.00 / $2,500.00