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Alaska rates for HCPCS A4392

Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.87 / $10.87 / $10.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $6.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $6.86 / $7.07
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.85 / $10.85 / $17.13
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $11.15
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.03 / $11.15 / $23.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $9.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $9.19 / $14.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.52 / $5.69 / $10.91