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Maine 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
$3.66 / $4.80 / $4.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.20 / $4.20 / $4.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.54 / $5.03 / $6.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $4.28 / $5.92
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.83 / $6.83 / $6.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.40 / $4.80 / $6.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.78 / $4.18 / $9.60