go back

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
$2.00 / $2.00 / $5.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.37
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $3.47 / $3.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.76 / $13.49 / $45.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.89 / $3.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.16 / $3.16 / $5.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.63 / $5.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.24 / $10.96
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
$6.76 / $6.76 / $6.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $2.04 / $5.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.57 / $4.07