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Illinois rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $24.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $14.79 / $24.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $61.66 / $208.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $17.78 / $17.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $26.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.49 / $16.98
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $21.88 / $33.88
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
$30.90 / $30.90 / $30.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.48 / $11.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $9.33 / $24.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $12.02 / $19.05