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Illinois rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.32 / $4.32 / $4.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.59 / $4.32 / $7.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.72 / $21.94 / $67.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.62 / $5.78 / $5.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $4.62 / $8.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $4.62 / $9.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $10.38 / $14.73
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
$10.01 / $10.01 / $10.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.66 / $9.63 / $11.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $3.84 / $6.59