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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
$9.46 / $9.46 / $9.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.46 / $9.46 / $9.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.02 / $11.03 / $11.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $12.56 / $12.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $12.56 / $19.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.65 / $11.42 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.86 / $5.69 / $9.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.53 / $12.56 / $15.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $14.67 / $24.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $5.69 / $7.30