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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
$15.85 / $15.85 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $15.14 / $19.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $35.48 / $50.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $16.98 / $16.98
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $16.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.49 / $16.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $9.33 / $12.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $11.22 / $14.45