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Minnesota 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
$5.34 / $5.34 / $5.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.66 / $5.34 / $6.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $8.94 / $11.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.70 / $8.13 / $8.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $25.86 / $71.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.75 / $10.34 / $12.38
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.36 / $24.82 / $56.56
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.75 / $9.75 / $10.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.37 / $8.38 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $3.94 / $8.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $3.94 / $11.06