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Indiana 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
$4.46 / $4.46 / $5.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.87 / $3.31 / $4.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.60 / $2.60 / $5.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $2.60 / $3.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.91 / $5.73 / $7.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.43 / $5.73 / $7.03
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 / $5.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $2.48 / $3.44