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Georgia rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $2.39 / $2.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $2.39 / $3.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.46 / $2.46 / $2.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $3.14 / $7.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.21 / $5.48 / $8.11
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.21 / $3.21 / $3.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $4.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.87 / $3.78 / $16.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.81 / $3.14