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North Carolina 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
$3.31 / $3.31 / $4.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $3.31 / $3.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.63 / $6.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.84 / $3.02
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 / $2.27 / $4.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $3.31 / $4.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.84 / $2.84 / $2.84
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $4.50 / $7.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.80 / $2.96
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.82 / $28.35 / $28.35