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Indiana 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
$7.80 / $7.80 / $9.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.03 / $5.79 / $7.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $4.55 / $8.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $4.55 / $6.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.83 / $10.02 / $13.67
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.74 / $10.02 / $12.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.47 / $9.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $4.34 / $6.02