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Nebraska 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
$8.91 / $8.91 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $8.91 / $50.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.96 / $11.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $7.59 / $12.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $13.18 / $19.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $16.22 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $5.75 / $11.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $12.59 / $28.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $28.84 / $28.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $5.25 / $7.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $5.37 / $8.71