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Illinois rates for HCPCS A4391

Ostomy Pouch Urinary With Extended Wear Barrier Attached (1 Piece) Each (Updated 01-01-2003) Ch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.55 / $5.55 / $5.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.30 / $5.55 / $9.86
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.42 / $6.42 / $6.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.90 / $27.44 / $86.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.93 / $7.40 / $7.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $10.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.93 / $11.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.86 / $14.22 / $18.43
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
$12.83 / $12.83 / $12.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.48 / $12.34 / $14.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.93 / $8.46