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Illinois rates for HCPCS A4425

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.81 / $2.81 / $2.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.54 / $2.81 / $5.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $2.88 / $2.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.85 / $13.72 / $43.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.93 / $3.75 / $3.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.01 / $5.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $5.68
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.83 / $5.83 / $10.67
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
$6.50 / $6.50 / $6.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.38 / $6.25 / $7.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $2.50 / $4.42