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Ohio 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
$5.01 / $7.24 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $5.01 / $7.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $8.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $5.25 / $11.22
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $8.71 / $8.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $6.46 / $10.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $7.76 / $11.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.25 / $5.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $5.25
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.25 / $11.75
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $5.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $6.31 / $9.12
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $10.00 / $18.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.09 / $3.89 / $5.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $4.07 / $5.50