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Illinois rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.93 / $2.93 / $2.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.93 / $5.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.95 / $14.09 / $45.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.05 / $3.91 / $3.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $5.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $3.13 / $6.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.03 / $7.29 / $11.38
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
$6.77 / $6.77 / $6.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $6.51 / $7.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $2.60 / $4.46