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Louisiana 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
$6.55 / $8.07 / $8.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.55 / $8.07 / $9.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.93 / $16.97 / $23.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.79 / $8.11 / $8.11
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $7.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $5.83 / $8.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.23 / $5.27 / $6.95