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Illinois rates for HCPCS A4389

Ostomy Pouch Drainable 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
$4.87 / $4.87 / $4.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.78 / $4.87 / $8.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.72 / $23.04 / $76.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.08 / $6.50 / $6.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $9.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $5.22 / $10.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.51 / $10.75 / $26.87
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
$11.27 / $11.27 / $11.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.94 / $10.84 / $13.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $4.33 / $7.44