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Illinois rates for HCPCS A5055

Stoma Cap (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.12 / $2.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.18 / $5.49 / $17.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.51 / $1.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $2.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $2.39
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.79 / $4.96
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
$2.61 / $2.61 / $2.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $2.73 / $3.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $1.00 / $1.76