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Illinois rates for HCPCS A4390

Ostomy Pouch Drainable With Extended Wear Barrier Attached With Built-In Convexity (1 Piece) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.53 / $7.53 / $7.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.84 / $7.53 / $13.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.72 / $7.72 / $7.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.67 / $36.31 / $117.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.86 / $10.06 / $10.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $14.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $15.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $16.18 / $34.04
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
$17.43 / $17.43 / $17.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.09 / $16.76 / $20.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.75 / $6.70 / $11.49