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Louisiana 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
$2.99 / $3.68 / $3.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.99 / $3.68 / $4.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.53 / $7.74 / $10.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.08 / $3.70 / $3.70
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $2.66 / $3.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $2.42 / $3.40