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Tennessee rates for HCPCS A4419

Ostomy pouch, closed; for use on barrier with nonlocking flange, with filter (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.53 / $2.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $1.40 / $1.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $2.17 / $2.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.45
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.88 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $18.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $1.12 / $1.52