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Missouri 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
$3.72 / $6.06 / $8.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.72 / $4.87 / $9.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.34 / $4.34 / $7.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $5.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $5.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.04 / $7.80 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.05 / $4.33 / $6.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.05 / $4.30 / $6.20