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Alaska rates for HCPCS A4387

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.99 / $2.99 / $2.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $1.95
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $4.71
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.75 / $3.07
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $3.07 / $6.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $2.49 / $6.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.57 / $3.00