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Iowa 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
$8.05 / $8.05 / $9.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.71 / $8.01 / $10.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $13.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.03 / $13.89 / $18.28
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.63 / $15.86 / $19.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.63 / $14.67 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.91 / $6.38 / $17.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.85 / $13.89 / $16.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.88 / $15.51 / $26.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.87 / $6.30 / $14.94
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.37 / $11.37 / $11.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.98 / $11.37 / $11.37