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Louisiana 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
$1.80 / $2.22 / $2.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $2.22 / $2.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.73 / $4.67 / $6.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $2.23 / $2.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $2.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $3.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $1.57 / $2.78