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Illinois rates for HCPCS A5121

Skin Barrier; Solid 6 X 6 Or Equivalent Each (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.85 / $5.85 / $5.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.85 / $5.85 / $10.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $6.38 / $6.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.72 / $26.30 / $91.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.85 / $7.81 / $7.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.26 / $6.26 / $11.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.32 / $6.26 / $11.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.33 / $11.12 / $17.78
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
$12.30 / $12.30 / $13.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.70 / $14.16 / $15.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.68 / $5.15 / $8.92