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North Carolina 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
$2.75 / $2.75 / $2.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.75 / $2.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.91 / $4.66 / $5.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.36 / $2.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $2.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $3.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $2.75 / $5.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $4.00 / $4.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.79 / $2.78
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $90.00 / $90.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.64 / $23.55 / $23.55