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Minnesota 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 / $19.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $28.18 / $41.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $23.99 / $23.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $91.20 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $30.20 / $35.48
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $89.13 / $169.82
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $29.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.23 / $23.99 / $112.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $10.23 / $26.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.16 / $9.33 / $9.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $11.48 / $28.18