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Georgia rates for HCPCS A4375

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $15.14 / $20.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $19.95 / $31.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $20.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.42 / $20.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.49 / $16.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $24.55 / $38.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $9.33 / $13.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $11.48 / $20.89