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Illinois rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $10.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.03 / $10.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $6.46 / $6.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $26.92 / $85.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $7.41 / $7.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $5.89 / $10.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $10.96
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $14.13 / $18.62
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
$12.88 / $12.88 / $12.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $4.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.82 / $3.80 / $10.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.90 / $7.76