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Nebraska 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
$3.13 / $3.13 / $3.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $3.64 / $3.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $4.16 / $4.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $4.16 / $6.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.82 / $3.78 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.88 / $3.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.15 / $4.16 / $5.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.41 / $4.86 / $8.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.88 / $2.50