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Nebraska rates for HCPCS A4375

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.87 / $19.87 / $19.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.87 / $19.87 / $26.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.09 / $23.19 / $23.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $26.39 / $26.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $27.75 / $40.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.16 / $23.99 / $112.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.11 / $11.97 / $19.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.31 / $26.39 / $33.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.62 / $30.83 / $52.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.43 / $11.97 / $15.96