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Alaska rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.96 / $4.96 / $4.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $3.13 / $3.22
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $4.95 / $7.82
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $4.55 / $5.09
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.11 / $5.09 / $10.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $4.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.13 / $4.19 / $6.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.60 / $4.98