go back

Illinois rates for HCPCS A5052

Ostomy pouch, closed; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.16 / $5.37 / $18.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.55 / $1.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.26 / $2.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $2.24
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $6.61 / $8.51
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
$2.69 / $2.69 / $2.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.83 / $2.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $1.05 / $1.66