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Illinois rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $6.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $6.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.33 / $16.22 / $52.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $4.47 / $4.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $6.61
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $9.55 / $12.88
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
$7.76 / $7.76 / $7.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.69 / $2.69 / $2.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $2.34 / $6.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $3.02 / $4.68