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Illinois rates for HCPCS A5073

Ostomy Pouch Urinary; For Use On Barrier With Flange (2 Piece) Each (Updated 01-01-2003) Cm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $2.50 / $4.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.80 / $11.21 / $38.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.69 / $3.33 / $3.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.67 / $2.67 / $4.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.67 / $5.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.36 / $6.50 / $8.80
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
$5.77 / $5.77 / $5.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.01 / $6.04 / $6.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $2.21 / $3.80