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California rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.39 / $3.71 / $36.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.45 / $5.52 / $36.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $5.49 / $14.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.33 / $6.33 / $11.75
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.30 / $17.28 / $26.70
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.83 / $27.10 / $47.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $10.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $6.45 / $8.75
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.10 / $12.63 / $15.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.58 / $8.84 / $19.57
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.90 / $62.90 / $94.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.89 / $25.89 / $25.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.46 / $11.17 / $12.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $7.59 / $11.41
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.83 / $23.83 / $23.83
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.10 / $14.78 / $19.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.87 / $5.36 / $12.00