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Maine rates for HCPCS A4389

Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $5.01 / $17.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $6.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $5.25 / $6.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $6.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $9.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $6.03 / $17.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.40 / $3.39 / $3.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $4.57 / $7.59