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Nebraska 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
$2.60 / $2.60 / $2.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $2.60 / $3.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $3.04 / $3.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $3.45 / $3.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $3.45 / $5.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $3.44 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.58 / $3.37
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $3.45 / $4.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.29 / $4.13 / $6.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.57 / $3.31