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Vermont 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
$1.99 / $2.56 / $2.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.06 / $3.06
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 / $2.80
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.80
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.27 / $2.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $2.29 / $4.37