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Iowa rates for HCPCS A4389

Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.53 / $5.53 / $6.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $5.51 / $7.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $9.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.78 / $9.53 / $12.66
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.92 / $8.67 / $14.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.94 / $10.08 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.38 / $4.38 / $11.86
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.52 / $9.53 / $11.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.48 / $11.08 / $18.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.35 / $4.33 / $11.27
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.80 / $7.80 / $7.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.16 / $7.80 / $7.80