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Tennessee 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
$6.52 / $6.52 / $8.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $8.00 / $11.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.53 / $11.37 / $11.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $6.45 / $8.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.64 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.90 / $62.90 / $94.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.04 / $5.88 / $8.07