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Minnesota rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.32 / $3.32 / $3.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $3.32 / $3.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $5.56 / $7.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $5.05 / $5.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $16.55 / $45.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.36 / $7.62
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.83 / $15.73 / $36.20
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $5.21 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $2.35 / $5.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $2.21 / $5.23