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Ohio rates for HCPCS A4420

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.26 / $1.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $2.14 / $3.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.00 / $3.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.86 / $3.02
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $1.62 / $2.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.69 / $50.12
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $75.86