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Arizona 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
$2.85 / $5.47 / $7.98
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $6.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.41 / $8.69 / $15.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.02 / $8.02 / $10.93
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 / $4.65 / $6.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $6.51 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.08 / $3.86 / $5.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.27 / $3.86 / $5.81