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Louisiana rates for HCPCS A4425

Ostomy pouch, drainable; for use on barrier with nonlocking flange, with filter (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.87 / $3.54 / $3.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.87 / $3.54 / $3.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $4.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.34 / $7.44 / $10.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.97 / $3.55 / $3.55
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.41 / $121.41 / $121.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.01 / $3.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $5.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $2.31 / $3.27