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Ohio 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
$2.00 / $2.00 / $6.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.00 / $2.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.76 / $6.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.36 / $3.14 / $4.24
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $3.14 / $6.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $4.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.61
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $3.98
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $2.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $2.20 / $2.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.57 / $3.18