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California rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $7.08 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $15.14 / $91.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $11.48 / $28.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $26.30
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $34.67 / $51.29
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $44.67 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $15.85 / $16.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.49 / $13.49
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $26.92 / $33.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $21.88 / $42.66
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $181.97 / $181.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $23.99 / $23.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $22.91 / $31.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $13.49 / $17.78
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $19.50 / $21.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $9.12 / $10.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $10.72 / $23.99