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Alaska rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.92 / $12.92 / $12.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $8.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $3.68 / $3.68
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.74 / $12.90 / $20.37
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $11.75 / $13.26
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.74 / $13.26 / $27.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $3.68 / $11.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.07 / $10.94 / $16.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.56 / $6.77 / $12.98