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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
$3.02 / $6.03 / $10.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $8.71 / $8.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $7.08 / $8.71
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $8.13 / $15.85
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $8.13 / $15.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.89 / $7.76 / $10.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $8.71 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.82 / $3.24 / $3.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $3.55 / $4.17