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Illinois rates for HCPCS A4389

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $5.01 / $8.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $21.88 / $75.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $6.46 / $6.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $5.25 / $9.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $9.55
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $10.72 / $20.89
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
$11.22 / $11.22 / $11.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $3.39 / $8.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $4.37 / $6.92