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California rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.61 / $1.76 / $17.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.76 / $2.70 / $17.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.16 / $2.60 / $6.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $5.57
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.32 / $8.21 / $12.68
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $12.85 / $22.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.43 / $3.60 / $5.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.06 / $4.17
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $5.99 / $7.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.59 / $4.19 / $9.27
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.83 / $29.83 / $44.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.27 / $12.27 / $12.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $5.30 / $5.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.60 / $5.70
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.30 / $11.30 / $11.30
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.54 / $5.88