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Illinois rates for HCPCS A4392

Ostomy Pouch Urinary With Standard Wear Barrier Attached With Built-In Convexity (1 Piece) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.41 / $6.41 / $6.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.97 / $6.41 / $11.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.48 / $30.89 / $100.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.69 / $8.57 / $8.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $12.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $6.86 / $13.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.24 / $16.48 / $21.49
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
$14.85 / $14.85 / $14.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.44 / $14.28 / $17.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $5.69 / $9.77