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Illinois rates for HCPCS A4421

Ostomy Supply; Miscellaneous (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.55 / $22.55 / $22.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.17 / $19.17 / $22.55
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $200.00 / $345.40
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.00 / $2,500.00 / $2,500.00