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Maryland 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
$1.52 / $1.99 / $2.75
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.75
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 / $1.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.20 / $3.14 / $4.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $2.18 / $3.18
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $4.20