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Tennessee 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
$4.71 / $4.71 / $5.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.96 / $5.77 / $7.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.23 / $5.23 / $5.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $8.19 / $8.19
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 / $4.65 / $6.43
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.48 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.37 / $45.37 / $68.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.91 / $4.23 / $5.53