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Tennessee rates for HCPCS A4425

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.59 / $2.59 / $3.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.18 / $3.09 / $4.38
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.59 / $2.59 / $2.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.99 / $4.50 / $4.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.01 / $3.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $3.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.15 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.90 / $24.90 / $37.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.33 / $3.20