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Ohio 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
$5.79 / $5.79 / $17.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.45 / $5.79 / $7.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.29 / $7.29 / $7.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $4.55 / $11.84
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.11 / $9.11 / $9.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.83 / $9.11 / $12.30
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $9.11 / $19.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $10.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $6.43
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.79
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.47 / $6.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.91 / $4.23 / $5.81