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Alaska rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.76 / $5.76 / $5.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.60 / $3.71
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.69 / $5.75 / $9.08
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.24 / $5.24 / $5.91
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.80 / $5.91 / $12.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.64 / $5.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $4.88 / $7.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.02 / $5.78