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Tennessee 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
$4.32 / $4.32 / $5.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.64 / $5.30 / $7.32
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.32 / $4.32 / $5.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.99 / $7.54 / $7.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $5.03 / $5.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $4.28 / $5.92
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.01 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.73 / $41.73 / $62.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.68 / $3.89 / $5.09