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California 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
Facility
Modifier
Low / Median / High Price
$2.44 / $2.67 / $26.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $4.09 / $26.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.28 / $3.95 / $10.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $4.55 / $8.47
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.58 / $12.44 / $19.22
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.92 / $19.55 / $34.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $7.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $6.15
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.29 / $9.11 / $10.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.47 / $6.38 / $14.12
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.37 / $45.37 / $68.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.67 / $18.67 / $18.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $8.03 / $9.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.47 / $8.67
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.18 / $17.18 / $17.18
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.29 / $10.66 / $13.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $3.86 / $9.10