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California rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.06 / $2.25 / $22.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.10 / $3.36 / $22.21
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $7.70 / $7.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.77 / $3.34 / $8.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.85 / $3.85 / $7.16
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.10 / $10.52 / $16.25
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.16 / $16.51 / $28.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.40 / $4.62 / $6.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $3.93 / $5.71
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.16 / $7.70 / $9.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.62 / $5.39 / $11.94
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
$38.35 / $38.35 / $57.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.78 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $6.80 / $7.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $4.62 / $6.96
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.52 / $14.52 / $14.52
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.16 / $9.02 / $11.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.95 / $3.26 / $7.31