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Illinois rates for HCPCS D9630

Drugs Or Medicaments Dispensed In The Office For Home Use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.13 / $7.13 / $7.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.05 / $7.78 / $20.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $150.00 / $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
$30.00 / $30.00 / $30.00