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Illinois rates for HCPCS A5053

Ostomy Pouch Closed; For Use On Faceplate Each (Updated 01-01-2003)

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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.18 / $6.11 / $21.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.81 / $1.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $2.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $2.29
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $4.04 / $5.45
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
$2.67 / $2.67 / $3.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $3.28 / $3.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.21 / $2.13