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Illinois rates for HCPCS A4419

Ostomy pouch, closed; for use on barrier with nonlocking flange, with filter (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.35 / $2.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $1.40 / $1.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.18 / $6.11 / $21.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.81 / $1.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.45 / $2.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.23 / $2.65
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $3.00 / $5.50
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
$3.13 / $3.13 / $3.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $3.01 / $3.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.20 / $2.06