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Louisiana rates for HCPCS A4375

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.77 / $16.96 / $16.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.77 / $16.96 / $18.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.88 / $35.68 / $50.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.25 / $17.03 / $17.03
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $16.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $13.54 / $16.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.78 / $11.17 / $15.68