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Idaho 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
$1.78 / $4.26 / $4.26
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 / $1.61 / $2.22
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $2.50 / $4.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.83 / $2.98 / $3.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.26 / $3.14 / $5.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.20 / $2.20 / $3.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.33 / $2.78