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Iowa rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.28 / $7.28 / $8.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.35 / $7.25 / $9.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $12.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.64 / $12.56 / $16.41
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.42 / $16.18 / $18.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.81 / $13.28 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $5.76 / $15.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.53 / $12.56 / $15.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.84 / $14.42 / $24.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $5.69 / $13.45
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.28 / $10.28 / $10.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.11 / $10.28 / $10.28