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Alaska rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.67 / $8.67 / $8.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.47 / $5.63
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.65 / $8.65 / $13.67
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.98 / $7.98 / $8.90
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.20 / $8.90 / $18.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $7.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.47 / $7.33 / $11.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.54 / $4.54 / $8.71