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Maine 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
Professional
Modifier
Low / Median / High Price
$1.65 / $2.17 / $2.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $2.27 / $2.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.11 / $2.67
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $3.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.17 / $2.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.98 / $4.34