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Maine rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.98 / $15.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $3.89 / $5.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.57 / $6.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $3.89 / $5.50
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $8.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $5.01 / $15.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $2.95 / $2.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $3.98 / $6.76