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Alaska 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
Professional
Modifier
Low / Median / High Price
$7.97 / $7.97 / $7.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $5.03 / $5.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $5.03 / $5.18
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.96 / $7.96 / $12.57
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.33 / $7.33 / $8.18
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.62 / $8.18 / $16.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.29 / $6.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.03 / $6.74 / $10.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.04 / $4.18 / $8.00