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Illinois rates for HCPCS A4390

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

Facilitymedian $14 · 10th–90th $7–$780%20%10th90th$14Professionalmedian $9 · 10th–90th $6–$140%20%10th90th$9$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.08 / $7.08 / $13.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $7.94 / $13.80
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.76 / $7.76 / $7.76
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.42 / $34.67 / $117.49
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $10.00 / $10.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.13 / $8.13 / $15.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.92 / $6.92 / $14.79
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.48 / $16.22 / $32.36
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.38 / $17.38 / $17.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $6.03 / $6.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.72 / $5.25 / $13.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.79 / $6.76 / $10.96