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Montana 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
$7.18 / $24.15 / $24.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.18 / $8.18 / $8.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $8.80 / $8.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.18 / $8.80 / $8.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.08 / $8.38 / $8.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $6.60 / $8.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $3.55 / $4.05