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Illinois rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.16 / $5.62 / $20.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.82 / $1.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $1.38 / $2.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.66
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $4.07 / $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
$2.69 / $3.16 / $3.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.93 / $2.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.20 / $1.82