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Missouri rates for HCPCS A4375

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

Facilitymedian $18 · 10th–90th $10–$490%10%20%10th90th$18Professionalmedian $14 · 10th–90th $10–$230%10%10th90th$14$2.0$5.0$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.00 / $22.91 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $15.14 / $25.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.59 / $22.39
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $14.79 / $24.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $15.85 / $16.60
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $13.49 / $13.49
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.02 / $20.42 / $112.20
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $12.02 / $120.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.51 / $9.33 / $15.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $11.48 / $18.20