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Illinois rates for HCPCS A4398

Ostomy Irrigation Supply; Bag Each (Special Coverage Instructions Apply. See Mcm: 2130a)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.84 / $10.84 / $10.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.01 / $10.84 / $19.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.21 / $52.24 / $169.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.81 / $14.48 / $14.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.60 / $11.60 / $21.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.86 / $11.60 / $22.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.34 / $34.15 / $46.08
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
$25.10 / $25.10 / $25.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.75 / $26.26 / $28.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.83 / $9.64 / $16.92