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Connecticut rates for HCPCS A4387

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $2.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $2.95 / $4.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $1.62 / $1.62
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.29 / $3.16
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.45 / $2.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.58 / $3.16