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Minnesota 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
$5.81 / $5.81 / $5.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.81 / $6.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $9.71 / $12.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.29 / $8.84 / $9.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $27.93 / $77.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.50 / $11.13 / $13.34
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.57 / $26.80 / $61.09
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.50 / $10.50 / $10.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.56 / $9.11 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $4.28 / $9.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $3.86 / $9.14