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Missouri 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
$1.62 / $2.64 / $3.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $2.12 / $4.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $3.12
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 / $2.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.76 / $3.40 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.88 / $3.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.88 / $2.84