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Alaska rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.49 / $9.49 / $9.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $5.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.93 / $6.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $2.70 / $2.70
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.38 / $9.47 / $14.96
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.65 / $8.65 / $9.74
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.89 / $9.74 / $20.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $2.70 / $8.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.93 / $8.03 / $12.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.82 / $4.97 / $9.52