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Indiana rates for HCPCS A4377

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $5.13 / $5.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $3.80 / $5.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $3.00 / $5.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $4.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.49 / $6.59 / $8.99
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $6.59 / $8.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.60 / $6.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $2.86 / $3.98