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Nebraska rates for HCPCS A4377

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.96 / $4.96 / $4.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.96 / $4.96 / $6.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.79 / $5.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $6.59 / $6.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $6.59 / $10.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.54 / $5.99 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.99 / $4.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.57 / $6.59 / $8.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.40 / $7.76 / $13.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.99 / $3.92