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Illinois rates for HCPCS A5072

Ostomy Pouch Urinary; Without Barrier Attached (1piece) Each (Updated 01-01-2003) 30)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $2.70 / $2.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.18 / $2.70 / $4.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.36 / $12.15 / $42.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.86 / $2.86 / $5.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.43 / $4.91
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.79 / $4.74 / $6.73
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
$6.25 / $6.25 / $6.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.28 / $6.54 / $7.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.40 / $4.25