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Illinois rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $3.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $13.18 / $27.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.34 / $2.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $1.91 / $3.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $1.62 / $3.47
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $4.79 / $6.17
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
$4.07 / $4.07 / $4.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $2.34 / $2.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.58 / $3.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.66 / $3.47