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Tennessee 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
$1.62 / $1.62 / $2.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.99 / $2.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $2.83 / $2.83
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 / $2.22
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.37 / $90.00 / $90.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.64 / $15.64 / $23.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.58 / $3.18