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Illinois rates for HCPCS A4376

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $67.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $40.74 / $67.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $173.78 / $575.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $50.12 / $50.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $72.44
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $83.18 / $107.15
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
$87.10 / $87.10 / $87.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $25.70 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $33.11 / $52.48