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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
$37.33 / $37.33 / $37.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.00 / $37.33 / $66.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.35 / $179.85 / $582.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.95 / $49.86 / $49.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.94 / $39.94 / $73.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.95 / $39.94 / $77.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.48 / $82.55 / $106.95
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
$86.42 / $86.42 / $86.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.68 / $83.10 / $99.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.50 / $33.17 / $56.94