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Maine rates for HCPCS A4375

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $15.14 / $47.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $16.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $19.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.49 / $16.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $25.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $16.98 / $47.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $9.33 / $9.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $12.59 / $21.38