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Arkansas rates for HCPCS A4417

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.19 / $4.19 / $4.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $4.19 / $4.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $3.30 / $3.30
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
$6.62 / $6.62 / $6.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.21 / $5.21 / $5.21
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.21 / $5.21 / $5.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $3.13 / $3.68
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $2.35 / $3.13