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Ohio rates for HCPCS A4377

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $5.01 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.55 / $7.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $4.47 / $7.24
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $5.37 / $8.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.47 / $3.63 / $4.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $3.63
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.47 / $3.63 / $8.13
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $3.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $4.47 / $6.46
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.92 / $12.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $2.51 / $3.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $2.82 / $3.80