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Illinois rates for HCPCS A4415

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 in, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.70 / $4.70 / $4.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.91 / $4.70 / $8.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.72 / $22.64 / $73.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.91 / $6.29 / $6.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $5.03 / $9.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $5.03 / $9.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.38 / $10.60 / $16.70
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
$10.89 / $10.89 / $10.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.99 / $10.48 / $12.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.95 / $4.18 / $8.69