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Illinois rates for HCPCS A4387

Ostomy Pouch Closed With Barrier Attached With Built-In Convexity (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.76 / $1.76 / $1.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $1.94 / $3.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.75 / $12.90 / $27.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.36 / $2.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $3.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $3.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $4.80 / $6.23
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
$4.08 / $4.08 / $4.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.35 / $3.93 / $4.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.66 / $3.97