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California 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
$1.39 / $1.53 / $15.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $2.35 / $15.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.87 / $2.25 / $5.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $2.60 / $4.84
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.48 / $7.12 / $11.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $11.18 / $19.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $4.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $3.62
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $5.21 / $6.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.13 / $3.65 / $8.08
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.95 / $25.95 / $39.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.68 / $10.68 / $10.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $4.59 / $5.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $3.13 / $4.75
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.82 / $9.82 / $9.82
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $6.10 / $7.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.21 / $4.84