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Arkansas rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.20 / $6.20 / $6.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.35 / $6.20 / $6.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $4.88 / $4.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $9.77 / $9.77
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.70 / $7.70 / $7.70
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $7.70 / $7.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.44 / $4.62 / $5.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $4.62 / $5.71
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $5.62 / $5.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.18 / $3.50 / $4.62